Provider Demographics
NPI:1710903158
Name:DI PIETRO, OLIVER R (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:R
Last Name:DI PIETRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1045 95TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2108
Mailing Address - Country:US
Mailing Address - Phone:305-993-4400
Mailing Address - Fax:305-993-4402
Practice Address - Street 1:1045 95TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2108
Practice Address - Country:US
Practice Address - Phone:305-993-4400
Practice Address - Fax:305-993-4402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 40033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036305700Medicaid
FL94081Medicare ID - Type Unspecified
FL036305700Medicaid