Provider Demographics
NPI:1699715854
Name:SIROTA, ALAN D (DPM)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:SIROTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 RED BUG LAKE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5916
Mailing Address - Country:US
Mailing Address - Phone:407-695-7075
Mailing Address - Fax:407-695-2069
Practice Address - Street 1:2911 RED BUG LAKE RD STE 300
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5916
Practice Address - Country:US
Practice Address - Phone:407-695-7075
Practice Address - Fax:407-695-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1395213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0801620001Medicare NSC
FL87744Medicare ID - Type Unspecified
FLT85781Medicare UPIN