MEDICARE: ERIC S TRATHEN DPM INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3472	FL

General Provider Information

NPI Number	:	1649664426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC S TRATHEN DPM INC

Provider Business Mailing Address
First Line	:	12630 WORLD PLAZA LN
Second Line	:	70
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3987
Country	:	US
Telephone Number	:	239-689-1235
Fax Number	:	239-274-8319

Provider Business Practice Location Address
First Line	:	12630 WORLD PLAZA LN
Second Line	:	70
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3987
Country	:	US
Telephone Number	:	239-689-1235
Fax Number	:	239-274-8319

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. ERIC STEPHEN TRATHEN
Credential	:	DPM
Telephone Number	:	239-689-1235

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	03/19/2015

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