Healthcare Provider Details

I. General information

NPI: 1548780307
Provider Name (Legal Business Name): HANNAH KHLOPAS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 08/07/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 SE 17TH ST STE 102
OCALA FL
34471-5550
US

IV. Provider business mailing address

2760 SE 17TH ST STE 102
OCALA FL
34471-5550
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-1555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002694
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5951000965
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: