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NPI Code Detail

MEDICARE: THEODORE P COULURIS DPM

MEDICARE: THEODORE P COULURIS 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
1213ES0103XFoot & Ankle Surgery PodiatristPO3020FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00017734OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598721185
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEODORE P COULURIS DPM
Provider Business Mailing Address
First Line : 2521 COUNTRYSIDE BLVD
Second Line :
City : CLEARWATER
State : FL
Zip : 33763-1605
Country : US
Telephone Number : 727-797-5008
Fax Number : 797-791-1330
Provider Business Practice Location Address
First Line : 2521 COUNTRYSIDE BLVD
Second Line :
City : CLEARWATER
State : FL
Zip : 33763-1605
Country : US
Telephone Number : 727-797-5008
Fax Number : 797-791-1330
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2006
Last Update Date : 07/11/2008

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Directions to “ THEODORE P COULURIS DPM” Practice Location

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