Provider Demographics
NPI:1689620585
Name:GUAITOLI, GIUSEPPE (MD)
Entity Type:Individual
Prefix:
First Name:GIUSEPPE
Middle Name:
Last Name:GUAITOLI
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 1:9776 BONITA BEACH RD
Mailing Address - Street 2:SUITE 202-A
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4773
Mailing Address - Country:US
Mailing Address - Phone:239-947-4822
Mailing Address - Fax:239-947-9150
Practice Address - Street 1:9776 BONITA BEACH RD
Practice Address - Street 2:SUITE 202-A
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4773
Practice Address - Country:US
Practice Address - Phone:239-947-4822
Practice Address - Fax:239-947-9150
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62930OtherBLUE CROSS PROVIDER
FL274552600Medicaid
FL223882881OtherTRICARE PROVIDER
FL62930ZMedicare PIN
FL274552600Medicaid
FL223882881OtherTRICARE PROVIDER