Provider Demographics
NPI:1710012349
Name:TJAMALOUKAS, KATHY GEORGIOU (DPM)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:GEORGIOU
Last Name:TJAMALOUKAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 STONEWOOD PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6213
Mailing Address - Country:US
Mailing Address - Phone:813-909-0865
Mailing Address - Fax:
Practice Address - Street 1:2716 STONEWOOD PARK LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-6213
Practice Address - Country:US
Practice Address - Phone:813-909-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3238213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AD592YMedicare PIN