Provider Demographics
NPI:1588733315
Name:SUNCOAST PODIATRY ASSOC
Entity type:Organization
Organization Name:SUNCOAST PODIATRY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-861-0444
Mailing Address - Street 1:3301 SW 34TH CIRCLE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-861-0444
Mailing Address - Fax:352-861-0464
Practice Address - Street 1:3301 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474
Practice Address - Country:US
Practice Address - Phone:352-861-0444
Practice Address - Fax:352-861-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1311260001Medicare NSC
21589Medicare ID - Type Unspecified