MEDICARE: PHILLIP D.DECUBELLIS 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
1	213ES0103X	Foot & Ankle Surgery Podiatrist

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
2	K1117	OTHER	FL	PTAN

General Provider Information

NPI Number	:	1730239575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILLIP D.DECUBELLIS PA

Provider Business Mailing Address
First Line	:	2828 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4206
Country	:	US
Telephone Number	:	954-776-5700
Fax Number	:	954-776-5701

Provider Business Practice Location Address
First Line	:	2828 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4206
Country	:	US
Telephone Number	:	954-776-5700
Fax Number	:	954-776-5701

Authorized Official
Title or Position	:	PODIATRIC
Name	:	PHILLIP D DECUBELLIS
Credential	:	DPM
Telephone Number	:	954-776-5700

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	01/02/2014

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