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General NPI Number Information
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NPI Number | 1730579830
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Entity Type | Organization
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Legal Business Name | DR PATRICK TREVISANI DPM
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 500 STATE ROAD 436 SUITE 2092
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City | CASSELBERRY
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State | FL
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Zip | 32707-5387
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Country | US
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Telephone | 407-810-6383
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Fax | 407-331-5084
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Provider Business Mailing Address
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Address Line | PO BOX 650
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City | WINTER PARK
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State | FL
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Zip | 32790-0650
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Country | US
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Telephone | 407-331-3470
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Fax | 407-699-6706
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. PATRICK J TREVISANI
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Credential | DPM
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Telephone | 407-810-6383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P00001844
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License Number State | FL
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