Provider Demographics
NPI:1194130211
Name:AGARUNOV, KONSTANTIN (DPM)
Entity type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:
Last Name:AGARUNOV
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 SW 124TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5847
Mailing Address - Country:US
Mailing Address - Phone:718-664-7482
Mailing Address - Fax:
Practice Address - Street 1:6707 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1536
Practice Address - Country:US
Practice Address - Phone:727-896-4615
Practice Address - Fax:727-256-3855
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3990213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3990OtherFLORIDA STATE LICENSE
FL101900200OtherFL MEDICAID