Provider Demographics
NPI:1033590633
Name:GULFCOAST MEDICAL HOUSECALLS, LLC
Entity Type:Organization
Organization Name:GULFCOAST MEDICAL HOUSECALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:DRATLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-731-6677
Mailing Address - Street 1:24430 SANDHILL BLVD
Mailing Address - Street 2:ATT NPP UNIT 303
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5216
Mailing Address - Country:US
Mailing Address - Phone:941-244-4414
Mailing Address - Fax:941-244-4415
Practice Address - Street 1:24430 SANDHILL BLVD
Practice Address - Street 2:ATT NPP UNIT 303
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5216
Practice Address - Country:US
Practice Address - Phone:941-244-4414
Practice Address - Fax:941-244-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37001261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center