MEDICARE: DR. JANET L BLACK DPM

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	213ES0131X	Foot Surgery Podiatrist	PO1752	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480028889	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	87999	OTHER	FL	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1386633410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET L BLACK DPM

Provider Business Mailing Address
First Line	:	3651 LAKE CENTER DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2364
Country	:	US
Telephone Number	:	352-385-9156
Fax Number	:	352-385-9159

Provider Business Practice Location Address
First Line	:	3651 LAKE CENTER DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2364
Country	:	US
Telephone Number	:	352-385-9156
Fax Number	:	352-385-9159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	02/16/2009

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Directions to “ DR. JANET L BLACK DPM” Practice Location

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