Individual
MELISSA N PRUTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1005 DALE MABRY HWY, LUTZ, FL 33548-3021
(813) 549-5678
(813) 701-9132
Mailing address
15815 SHADDOCK DR STE 130, WINTER GARDEN, FL 34787-5773
(813) 400-1140
(813) 701-9132
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO4507
FL
213EP1101X
Primary Podiatric Medicine Podiatrist
PO4507
FL
213ES0000X
Sports Medicine Podiatrist
PO4507
FL
213ES0103X
Foot & Ankle Surgery Podiatrist
PO4507
FL
213ES0131X
Foot Surgery Podiatrist
PO4507
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119076100
—
FL
01
—
15584066
CAQH
—
01
—
3AEL6
FL BLUE BCBS ID
FL
Enumeration date
06/23/2022
Last updated
03/10/2025
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