Provider Demographics
NPI:1962683680
Name:FRANK BUSILLO DPM PA DBA TAFT PODIATRY ASSOCIATES
Entity type:Organization
Organization Name:FRANK BUSILLO DPM PA DBA TAFT PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-989-1786
Mailing Address - Street 1:6888 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5657
Mailing Address - Country:US
Mailing Address - Phone:954-989-1786
Mailing Address - Fax:
Practice Address - Street 1:6888 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5657
Practice Address - Country:US
Practice Address - Phone:954-989-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5854690001Medicare NSC
FLQ0562Medicare PIN