Provider Demographics
NPI:1235212267
Name:HACISKI, RAFAEL CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:CHRISTOPHER
Last Name:HACISKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 GOODLETTE RD N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5469
Mailing Address - Country:US
Mailing Address - Phone:239-692-9699
Mailing Address - Fax:
Practice Address - Street 1:671 GOODLETTE RD N
Practice Address - Street 2:SUITE 230
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5469
Practice Address - Country:US
Practice Address - Phone:239-692-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86280207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB70010Medicare UPIN
FL78992ZMedicare ID - Type Unspecified