Provider Demographics
NPI:1629077508
Name:REIS, IGOR LEVY (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:LEVY
Last Name:REIS
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 1:3451 PINE RIDGE RD BLDG 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:239-449-3072
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:877 111TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1866
Practice Address - Country:US
Practice Address - Phone:239-594-8002
Practice Address - Fax:239-594-3447
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME860332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40935BMedicare PIN
FLH78351Medicare UPIN
FL47892Medicare ID - Type Unspecified
FL40935Medicare PIN