Healthcare Provider Details

I. General information

NPI: 1518520360
Provider Name (Legal Business Name): YELIZAVETA KOTLYAROVA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 142ND AVE N
CLEARWATER FL
33760-2822
US

IV. Provider business mailing address

5900 LAKE ELLENOR DR STE 700
ORLANDO FL
32809-4643
US

V. Phone/Fax

Practice location:
  • Phone: 727-431-4850
  • Fax: 727-669-8417
Mailing address:
  • Phone: 407-352-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNONE
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: