Provider Demographics
NPI:1750477709
Name:CHINNAPPAN, BRITTO (MD)
Entity Type:Individual
Prefix:
First Name:BRITTO
Middle Name:
Last Name:CHINNAPPAN
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 1:9671 GLADIOLUS DR
Mailing Address - Street 2:UNIT 107
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7684
Mailing Address - Country:US
Mailing Address - Phone:239-418-1118
Mailing Address - Fax:
Practice Address - Street 1:9671 GLADIOLUS DR
Practice Address - Street 2:UNIT 107
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7684
Practice Address - Country:US
Practice Address - Phone:239-418-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269544800Medicaid
FLH70669Medicare UPIN