Healthcare Provider Details

I. General information

NPI: 1740288356
Provider Name (Legal Business Name): THOMAS SEAN ROUKIS DPM, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ROLLINS ST STE 11100
ORLANDO FL
32804-5570
US

IV. Provider business mailing address

16021 CITRUS KNOLL DR
WINTER GARDEN FL
34787-9473
US

V. Phone/Fax

Practice location:
  • Phone: 844-407-4070
  • Fax:
Mailing address:
  • Phone: 608-738-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: