Healthcare Provider Details

I. General information

NPI: 1376552737
Provider Name (Legal Business Name): CURTIS W SKUPNY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13761 MCGREGOR BLVD
FORT MYERS FL
33919-6120
US

IV. Provider business mailing address

PO BOX 61397
FORT MYERS FL
33906-1397
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-7100
  • Fax: 239-482-4209
Mailing address:
  • Phone: 239-482-7100
  • Fax: 239-482-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO 1727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: