MEDICARE: DR. COLETTE TARA D'ALTILIO 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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO 3030	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740251008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLETTE TARA D'ALTILIO DPM

Provider Business Mailing Address
First Line	:	2100 E SAMPLE RD
Second Line	:	SUITE 203
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7596
Country	:	US
Telephone Number	:	954-933-9033
Fax Number	:	954-934-0060

Provider Business Practice Location Address
First Line	:	2100 E SAMPLE RD
Second Line	:	SUITE 203
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7574
Country	:	US
Telephone Number	:	954-933-9033
Fax Number	:	954-934-0060

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2011

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