Healthcare Provider Details

I. General information

NPI: 1275504110
Provider Name (Legal Business Name): DANIEL L WIERNIK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W CRYSTAL LAKE ST STE 200
ORLANDO FL
32806-4476
US

IV. Provider business mailing address

25 W CRYSTAL LAKE ST STE 200
ORLANDO FL
32806-4476
US

V. Phone/Fax

Practice location:
  • Phone: 407-254-2500
  • Fax: 407-423-2789
Mailing address:
  • Phone: 407-254-2500
  • Fax: 407-423-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: