Provider Demographics
NPI:1548378110
Name:CENTRAL FLORIDA FOOT CARE, P.A.
Entity type:Organization
Organization Name:CENTRAL FLORIDA FOOT CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRZYSTAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-360-1360
Mailing Address - Street 1:PO BOX 491334
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1334
Mailing Address - Country:US
Mailing Address - Phone:352-360-1360
Mailing Address - Fax:352-360-0686
Practice Address - Street 1:305 CHILDS ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-360-1360
Practice Address - Fax:352-360-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2004213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65384OtherBLUE CROSS/BLUE SHIELD
65384AMedicare PIN
T21497Medicare UPIN
FL4665650001Medicare NSC