Provider Demographics
NPI:1053311944
Name:PIROTTA, STEPHEN SAMUEL (DPM)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:SAMUEL
Last Name:PIROTTA
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 1:903 SE 22ND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4196
Mailing Address - Country:US
Mailing Address - Phone:479-271-5353
Mailing Address - Fax:479-254-0698
Practice Address - Street 1:903 SE 22ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4196
Practice Address - Country:US
Practice Address - Phone:479-271-5353
Practice Address - Fax:479-254-0698
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR133213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129007717Medicaid
AR1114047438OtherNPI
480033075OtherRR MCR
4297280002Medicare NSC
55659Medicare PIN
AR129007717Medicaid