MEDICARE: COLLEEN DZIKOWSKI DPM LLC

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	213E00000X	Podiatrist	P02529	FL

General Provider Information

NPI Number	:	1891166773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEEN DZIKOWSKI DPM LLC

Provider Business Mailing Address
First Line	:	5800 COLONIAL DR STE 203
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5674
Country	:	US
Telephone Number	:	954-297-8267
Fax Number	:	954-337-0849

Provider Business Practice Location Address
First Line	:	5800 COLONIAL DR STE 203
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5674
Country	:	US
Telephone Number	:	954-297-8267
Fax Number	:	954-337-0849

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. COLLEEN DZIKOWSKI
Credential	:	DPM
Telephone Number	:	954-684-5716

Provider Enumeration Date	:	10/17/2015
Last Update Date	:	10/17/2015

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