Provider Demographics
NPI:1164771069
Name:ANTHONY J. WILLIAMITIS M D INC.
Entity Type:Organization
Organization Name:ANTHONY J. WILLIAMITIS M D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-947-6808
Mailing Address - Street 1:9200 BONITA BEACH RD SE
Mailing Address - Street 2:#105
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4280
Mailing Address - Country:US
Mailing Address - Phone:239-947-6808
Mailing Address - Fax:239-947-9625
Practice Address - Street 1:9200 BONITA BEACH RD SE
Practice Address - Street 2:#105
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4280
Practice Address - Country:US
Practice Address - Phone:239-947-6808
Practice Address - Fax:239-947-9625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty