MEDICARE: CORTEZ FOOT & ANKLE SPECIALISTS P.A.

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB2136	OTHER	FL	RR GROUP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215094776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORTEZ FOOT & ANKLE SPECIALISTS P.A.

Provider Business Mailing Address
First Line	:	1800 CORTEZ RD W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1335
Country	:	US
Telephone Number	:	941-758-8818
Fax Number	:	941-758-4438

Provider Business Practice Location Address
First Line	:	1800 CORTEZ RD W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-1335
Country	:	US
Telephone Number	:	941-758-8818
Fax Number	:	941-755-2901

Authorized Official
Title or Position	:	OFFICE SUPPORT MANANGER
Name	:	CARA L OLSON
Credential	:
Telephone Number	:	941-758-8818

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/21/2022

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1922158484 — MR. PABLO EDGARDO DER BOGHOSSIAN P.T.
Practice Location Address:

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