Healthcare Provider Details

I. General information

NPI: 1720017866
Provider Name (Legal Business Name): CENTRAL FLORIDA PODIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 CHARLES ST.
ORLANDO FL
32808
US

IV. Provider business mailing address

12180 28TH ST N
SAINT PETERSBURG FL
33716-1820
US

V. Phone/Fax

Practice location:
  • Phone: 407-209-7175
  • Fax: 407-523-9325
Mailing address:
  • Phone: 727-572-5449
  • Fax: 727-573-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3097
License Number StateFL

VIII. Authorized Official

Name: DR. AGNES KATARZYNA BARTOSZEK
Title or Position: PRESIDENT
Credential: D.P.M
Phone: 727-572-5449