Healthcare Provider Details

I. General information

NPI: 1063686756
Provider Name (Legal Business Name): STEPHEN PETROFSKY DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
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
PT 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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO000791
License Number StateFL

VIII. Authorized Official

Name: STEPHEN PETROFSKY
Title or Position: OWNER
Credential: DPM
Phone: 941-625-3330