Provider Demographics
NPI:1053585851
Name:COMPREHENSIVE FOOT AND ANKLE CENTER PA
Entity type:Organization
Organization Name:COMPREHENSIVE FOOT AND ANKLE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TJAMALOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-410-4988
Mailing Address - Street 1:2716 STONEWOOD PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6213
Mailing Address - Country:US
Mailing Address - Phone:813-909-0865
Mailing Address - Fax:813-949-9532
Practice Address - Street 1:2716 STONEWOOD PARK LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-6213
Practice Address - Country:US
Practice Address - Phone:813-909-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3177213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO112OtherRAILROAD MEDICARE
FL6139140001Medicare NSC