OrganizationActive
Elite Sports Podiatry, PA
NPI 1356743207 · Foot Surgery Podiatrist · Clearwater, FL
Provider details
- NPI number
- 1356743207
- Entity type
- Organization
- Primary specialty
- Foot Surgery PodiatristPodiatric Medicine & Surgery Service Providers
- Authorized official
- Brian Fullem, Medical Doctor/Owner
- License
- PO3445 (FL)
Practice location
1700 N Mcmullen Booth Rd
Suite C-2
Clearwater, FL 33759-2130
Phone: (727) 330-7646
Fax: (727) 330-4645
Mailing address
1700 N Mcmullen Booth Rd Ste C2
Clearwater, FL 33759-2129
Registry dates
- Enumerated
- 2014-09-23
- Last updated
- 2015-01-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.