MEDICARE: DR. MICHAEL BAHLATZIS D.P.M

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	004310	NY
2	363AS0400X	Surgical Physician Assistant	PA9115963	FL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	PO4569	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1700847217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BAHLATZIS D.P.M

Provider Business Mailing Address
First Line	:	9723 BLUE STONE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-6722
Country	:	US
Telephone Number	:	607-215-3887
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 W SAGAMORE AVE
Second Line	:
City	:	CLEWISTON
State	:	FL
Zip	:	33440-3514
Country	:	US
Telephone Number	:	863-902-3032
Fax Number	:

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

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	02/27/2025

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