MEDICARE: THEODORE JOSEPH PIANO D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO3080	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P03080	OTHER	FL	FLORIDA LICENSE NUMBER

General Provider Information

NPI Number	:	1306871827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE JOSEPH PIANO D.P.M.

Provider Business Mailing Address
First Line	:	4142 HANGING MOSS CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-7658
Country	:	US
Telephone Number	:	904-292-0665
Fax Number	:	904-292-0665

Provider Business Practice Location Address
First Line	:	4142 HANGING MOSS CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-7658
Country	:	US
Telephone Number	:	904-292-0665
Fax Number	:	904-292-0665

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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