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NPI Code Detail

MEDICARE: COMPREHENSIVE FOOT AND ANKLE CENTER PA

MEDICARE: COMPREHENSIVE FOOT AND ANKLE CENTER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristPO3177FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DO112OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053585851
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE FOOT AND ANKLE CENTER PA
Provider Business Mailing Address
First Line : 2716 STONEWOOD PARK LOOP
Second Line :
City : LAND O LAKES
State : FL
Zip : 34638-6213
Country : US
Telephone Number : 813-909-0865
Fax Number : 813-949-9532
Provider Business Practice Location Address
First Line : 2716 STONEWOOD PARK LOOP
Second Line :
City : LAND O LAKES
State : FL
Zip : 34638-6213
Country : US
Telephone Number : 813-909-0865
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. GEORGE TJAMALOUKAS
Credential : D.P.M.
Telephone Number : 727-410-4988
Provider Enumeration Date : 04/14/2008
Last Update Date : 09/03/2020

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Directions to “COMPREHENSIVE FOOT AND ANKLE CENTER PA ” Practice Location

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