Healthcare Provider Details

I. General information

NPI: 1710363692
Provider Name (Legal Business Name): ELLIOT FIALKOFF D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 N 41ST CT
HOLLYWOOD FL
33021-1940
US

IV. Provider business mailing address

3381 N 41ST CT
HOLLYWOOD FL
33021-1940
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-4127
  • Fax:
Mailing address:
  • Phone: 818-317-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberPR450
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPR450
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3970
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPR450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: