Healthcare Provider Details

I. General information

NPI: 1821051160
Provider Name (Legal Business Name): STEPHEN PETROFSKY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 HARBOR BLVD SUITE 206
PT CHARLOTTE FL
33952-5342
US

IV. Provider business mailing address

2525 HARBOR BLVD SUITE 206
PORT CHARLOTTE FL
33952-5342
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-3330
  • Fax: 941-625-5753
Mailing address:
  • Phone: 941-625-3330
  • Fax: 941-625-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO000791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: