Provider Demographics
NPI:1750682175
Name:JAMES VILLOTTI MD PA
Entity Type:Organization
Organization Name:JAMES VILLOTTI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:VILLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-474-0023
Mailing Address - Street 1:900 PINE ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-4418
Mailing Address - Country:US
Mailing Address - Phone:941-474-9581
Mailing Address - Fax:941-475-0748
Practice Address - Street 1:900 PINE ST
Practice Address - Street 2:SUITE 111
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4418
Practice Address - Country:US
Practice Address - Phone:941-474-9581
Practice Address - Fax:941-475-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51986OtherUPIN
FL10D0867516OtherCLIA
FL10D0867516OtherCLIA