Provider Demographics
NPI:1295034742
Name:AQUINO, EDWIN MICHEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:MICHEL
Last Name:AQUINO
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9633
Mailing Address - Fax:239-343-4015
Practice Address - Street 1:8960 COLONIAL CENTER DR STE 302
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7810
Practice Address - Country:US
Practice Address - Phone:239-343-9633
Practice Address - Fax:239-343-4015
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52301207RR0500X
FLME146779207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118767100Medicaid