Organization
COLLIER PODIATRY, P.A.
Active
Organization
COLLIER PODIATRY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN PETROCELLI DPM (PRESIDENT)
(239) 775-0019
Entity
Organization
Contact information
Practice address
1715 HERITAGE TRL, SUITE 204, NAPLES, FL 34112-8715
(239) 775-0019
(239) 775-0219
Mailing address
1715 HERITAGE TRL, SUITE 204, NAPLES, FL 34112-8715
(239) 775-0019
(239) 775-0219
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PO-2399
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811988165
NPI PERSONAL NUMBER
—
05
—
340308400
—
FL
01
—
4574474
AETNA NUMBER
FL
01
—
65356A
BCBS NUMBER
FL
01
—
PO-2399
STATE LICENSE NUMBER
FL
Enumeration date
05/06/2007
Last updated
03/07/2023
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