Provider Demographics
NPI:1861438111
Name:DAGROSSA, CHRISTOPHER (DPM)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:DAGROSSA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 NW 49TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2771
Mailing Address - Country:US
Mailing Address - Phone:954-741-1233
Mailing Address - Fax:954-344-7029
Practice Address - Street 1:11220 NW 49TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2771
Practice Address - Country:US
Practice Address - Phone:954-741-1233
Practice Address - Fax:954-344-7029
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1976213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU09595Medicare UPIN
FL65083EMedicare ID - Type Unspecified