Provider Demographics
NPI:1730579830
Name:DR PATRICK TREVISANI DPM
Entity type:Organization
Organization Name:DR PATRICK TREVISANI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TREVISANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-810-6383
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0650
Mailing Address - Country:US
Mailing Address - Phone:407-331-3470
Mailing Address - Fax:407-699-6706
Practice Address - Street 1:500 STATE ROAD 436
Practice Address - Street 2:SUITE 2092
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5387
Practice Address - Country:US
Practice Address - Phone:407-810-6383
Practice Address - Fax:407-331-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001844213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty