Provider Demographics
NPI:1235450370
Name:GIELOW, ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GIELOW
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 1:521 W STATE ROAD 434 STE 301
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5166
Mailing Address - Country:US
Mailing Address - Phone:407-767-5808
Mailing Address - Fax:407-767-5892
Practice Address - Street 1:521 W STATE ROAD 434 STE 301
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5166
Practice Address - Country:US
Practice Address - Phone:407-767-5808
Practice Address - Fax:407-767-5892
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013773207R00000X
FLUO4558390200000X
FLOS139262086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018231400Medicaid
FLIP805XMedicare PIN