ELITE SPORTS PODIATRY, PA (NPI# 1356743207) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356743207 |
| Entity Type | Organization |
| Organization Name | ELITE SPORTS PODIATRY, PA |
| Practice Address |
1700 N Mcmullen Booth Rd Suite C-2 Clearwater FL 33759-2130 |
| Mailing Address |
1700 N Mcmullen Booth Rd Ste C2 Clearwater FL 33759-2129 |
| Practice Telephone | 7273307646 |
| Practice Fax Number | 7273304645 |
| Mailing Telephone | 7273307646 |
| Mailing Fax Number | 7273307645 |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2015-01-07 |
| Authorized Official Name | DR. BRIAN WILLIAM FULLEM (MEDICAL DOCTOR/OWNER) |
| Authorized Official Telephone | 2032412582 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
PO3445 | FL | Podiatric Medicine & Surgery Service Providers |
| Street Address |
1700 N MCMULLEN BOOTH RD SUITE C-2 |
| City | CLEARWATER |
| State | FL |
| Zip Code | 33759-2130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619967528 | William Alvarez | Family Medicine | 1700 N Mcmullen Booth Rd, Suite C3, Clearwater, FL 33759-2130 | 2005-10-24 |
| 1922438498 | Lisa Cozzini | Nurse Practitioner | 1700 N Mcmullen Booth Rd, Suite D1, Clearwater, FL 33759-2130 | 2013-11-20 |
| 1386080612 | Vyacheslav Scott Gutkin | Family Medicine | 1700 N Mcmullen Booth Rd, Suite D1, Clearwater, FL 33759-2130 | 2013-05-14 |
| 1104166057 | Emma Zainabu Sandi | Nurse Practitioner | 1700 N Mcmullen Booth Rd, Suite D1, Clearwater, FL 33759-2130 | 2013-02-28 |
| 1184975492 | Saigi P Simon | Nurse Practitioner | 1700 N Mcmullen Booth Rd, Suite D1, Clearwater, FL 33759-2130 | 2012-09-26 |
| 1326315987 | Lucinda J Rau | Nurse Practitioner | 1700 N Mcmullen Booth Rd, D1, Clearwater, FL 33759-2130 | 2011-11-28 |
| 1932484367 | Innovative Spine Care, Inc. | Pain Medicine | 1700 N Mcmullen Booth Rd, Suite A2-1, Clearwater, FL 33759-2130 | 2011-10-17 |
| 1346560422 | Alcrista Investments, Inc. | Home Health | 1700 N Mcmullen Booth Rd, Suite B-3, Clearwater, FL 33759-2130 | 2010-06-11 |
| 1235369174 | Donna Faye Theiss | Nurse Practitioner | 1700 N Mcmullen Booth Rd, Suite D1, Clearwater, FL 33759-2130 | 2009-07-24 |
| 1619121639 | Zahid Mehmood Malik | Internal Medicine | 1700 N Mcmullen Booth Rd, Suite D1, Clearwater, FL 33759-2130 | 2008-11-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487163119 | Neil Hook, O.d. and Associates, P.a. | Optometrist | 2679 Gulf To Bay Blvd # 560-570, Clearwater, FL 33759 | 2017-09-26 |
| 1306366224 | Caitlin Elise Sullivan | Chiropractor | 3000 Gulf To Bay Blvd Ste 201, Clearwater, FL 33759 | 2017-06-21 |
| 1881018851 | Monica Adam | Counselor | 3491 Gandy Blvd., Suite 201, Pinellas Park, FLORIDA 33759 | 2014-02-12 |
| 1174868509 | Red River Rehabilitation | Skilled Nursing Facility | 549 Sky Harbor Dr, Bldg 31, Clearwater, FL 33759 | 2012-12-12 |
| 1336485762 | Red River Rehabilitation | Skilled Nursing Facility | 549 Sky Harbor Drive, Clearwater, FL 33759 | 2012-12-12 |
| 1710245279 | Allison H Aschenbrenner | Physical Therapist | 2790 Gulf To Bay Boulevard, Suite C, Clearwater, FL 33759 | 2012-05-02 |
| 1538454954 | Elizabeth M Smith | Occupational Therapist | 4902 Creekside Drive Suite A, Clearwater, FL 33759 | 2011-06-14 |
| 1487886164 | Christina D Brown | Psychologist | 1700 N Mcmullen Booth Rd Ste C1, Clearwater, FL 33759 | 2009-08-14 |
| 1548408248 | Len F. Leeb | Counselor | 2641 Harbor Circle, Clearwater, FL 33759 | 2009-02-03 |
| 1750544615 | Dolphin II Diagostics Inc. | Contractor | 1700 N. Mcmullen Booth Rd Unit B-3, Clearwater, FL 33759 | 2008-07-09 |
| Find all providers in zip 33759 | ||||
| Taxonomy Code | 213ES0131X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649413378 | Brenn Isidro Garriel | Podiatrist | 13600 Icot Blvd Bldg A, Clearwater, FL 33760-3703 | 2009-04-10 |
| 1114918919 | Matthew Dean Westerfield | Podiatrist | 13600 Icot Blvd, Bldg B, Clearwater, FL 33760-3703 | 2005-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487264826 | Upperline Healthcare, PC | Podiatrist | 819 E Oak St Ste B, Kissimmee, FL 34744-5842 | 2020-07-31 |
| 1801406236 | Upperline Healthcare, PC | Podiatrist | 499 E Central Pkwy Ste 120, Altamonte Springs, FL 32701-3449 | 2020-07-31 |
| 1841800281 | Upperline Healthcare, PC | Podiatrist | 7148 Curry Ford Rd Ste 300, Orlando, FL 32822-5803 | 2020-07-31 |
| 1497365829 | Upperline Healthcare, PC | Podiatrist | 6000 Turkey Lake Rd Ste 108, Orlando, FL 32819-4205 | 2020-07-31 |
| 1427668854 | Upperline Healthcare, PC | Podiatrist | 1381 Citrus Tower Blvd Ste 103, Clermont, FL 34711-1957 | 2020-07-31 |
| 1639654148 | Kenneth Shapiro | Podiatrist | 7209 Promenade Dr Apt 601, Boca Raton, FL 33433-2809 | 2018-10-01 |
| 1558872549 | Edward Nathan Szerlip | Podiatrist | 11960 Northwest 26 Street, Plantation, FL 33323-3332 | 2017-10-17 |
| 1174903686 | Maria Lilia Fundora Cabrera | Podiatrist | 1380 Ne Miami Gardens Dr 209, Miami, FL 33179-4709 | 2015-06-01 |
| 1285027599 | Naples Podiatry | Podiatrist | 4763 Tamiami Trail North, Naples, FL 34103 | 2015-03-11 |
| 1548667314 | Louis Joseph Falletta | Podiatrist | 410 Se 28th Ave, Pompano Beach, FL 33062-6130 | 2014-11-22 |
| Find all providers with the same taxonomy | ||||
| City | CLEARWATER |
| Zip Code | 33759 |
Please comment or provide details below to improve the information on ELITE SPORTS PODIATRY, PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.