Basic Information
| Provider Information | |||||||||
| NPI: | 1912971979 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOCIKER | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 WARRIOR TRL | ||||||||
| Address2: | |||||||||
| City: | ENTERPRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327252456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073760522 | ||||||||
| FaxNumber: | 4073863077 | ||||||||
| Practice Location | |||||||||
| Address1: | 2014 S ORANGE AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328063069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074231234 | ||||||||
| FaxNumber: | 4075171040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | PO 1323 | FL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 041065900 | 05 | FL | MEDICAID | P00099490 | 01 | FL | R/R MEDICARE | OTHER |