Provider Demographics
NPI:1063497600
Name:RIGANOTTI, DOMINIC R (DO)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:R
Last Name:RIGANOTTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH ST
Mailing Address - Street 2:SUITE 60
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1416
Mailing Address - Country:US
Mailing Address - Phone:754-206-2031
Mailing Address - Fax:754-206-2032
Practice Address - Street 1:1881 NE 26TH ST
Practice Address - Street 2:SUITE 60
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1416
Practice Address - Country:US
Practice Address - Phone:754-206-2031
Practice Address - Fax:754-206-2032
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG83952Medicare UPIN
FL51385SMedicare PIN