Organization Name: | SUSAN C JANNOU DPM PA |
NPI Number: | 1447434188 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN C JANNOU (OWNER) |
Mailing Address: | 2420 Tamiami Trl N Suite A Nokomis |
State: | FL US |
Postal Code: | 342753421 |
Phone Number: | 9419661777 |
Fax Number: | 9419668628 |
NPI Enumeration Date: | 12/18/2007 |
NPI Last Update Date: | 04/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213EP1101X |
License Number: | PO2384 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Primary Podiatric Medicine |
Taxonomy Definition: |