Healthcare Provider Details

I. General information

NPI: 1851578918
Provider Name (Legal Business Name): SCOTT P KURECKI DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12757 TAMIAMI TRL S
NORTH PORT FL
34287-1934
US

IV. Provider business mailing address

12757 TAMIAMI TRL S
NORTH PORT FL
34287-1934
US

V. Phone/Fax

Practice location:
  • Phone: 941-426-1167
  • Fax: 941-426-2571
Mailing address:
  • Phone: 941-426-1167
  • Fax: 941-426-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO0001946
License Number StateFL

VIII. Authorized Official

Name: RENEE KURECKI
Title or Position: OWNER/MANAGER
Credential:
Phone: 941-426-1167