Provider Demographics
NPI:1386105211
Name:PALKO, OLESYA (DPM)
Entity type:Individual
Prefix:
First Name:OLESYA
Middle Name:
Last Name:PALKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 EHRLICH RD FL 33624
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2038
Mailing Address - Country:US
Mailing Address - Phone:813-591-4570
Mailing Address - Fax:813-441-6116
Practice Address - Street 1:4915 EHRLICH RD FL 33624
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2038
Practice Address - Country:US
Practice Address - Phone:813-591-4570
Practice Address - Fax:813-441-6116
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4327213E00000X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBXJU7OtherBCBS INDIVIDUAL
FLPC375OtherMEDICARE INDIVIDUAL #