Healthcare Provider Details

I. General information

NPI: 1669769519
Provider Name (Legal Business Name): JOSEPH MICHAEL PUSATERI D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

IV. Provider business mailing address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-7000
  • Fax: 239-433-8999
Mailing address:
  • Phone: 239-481-7000
  • Fax: 239-433-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006271
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: