Collier Podiatry, P.a.

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

PO-2399 Issued in FL

Legal business name

COLLIER PODIATRY, P.A.

Practice address

1715 Heritage TRL
Suite 204
Naples, FL 34112-8715

Phone

(239) 775-0019

Fax

(239) 775-0219

NPI assigned

May 6, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael John Petrocelli, DPMNPI 1811988165

Title

President

Phone

(239) 775-0019

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael John Petrocelli, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Naples, FL
  • NPI 1811988165
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1164634556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 HERITAGE TRL",
            "address_2": "SUITE 204",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341128715",
            "telephone_number": "239-775-0019",
            "fax_number": "239-775-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 HERITAGE TRL",
            "address_2": "SUITE 204",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341128715",
            "telephone_number": "239-775-0019",
            "fax_number": "239-775-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER PODIATRY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-06",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "PETROCELLI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-775-0019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot Surgery",
            "state": "FL",
            "license": "PO-2399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340308400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI PERSONAL NUMBER",
            "identifier": "1811988165",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NUMBER",
            "identifier": "4574474",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "PO-2399",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NUMBER",
            "identifier": "65356A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot Surgery Podiatrist in Naples, FL
• Providers in Naples, FL by specialty
• Foot Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.