Provider Demographics
NPI:1770630725
Name:CRISTIAN J. PRESUTTI, M.D.,P.L.,
Entity Type:Organization
Organization Name:CRISTIAN J. PRESUTTI, M.D.,P.L.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRESUTTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-398-9808
Mailing Address - Street 1:1701 SE HILLMOOR DR STE 7
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7552
Mailing Address - Country:US
Mailing Address - Phone:772-398-9808
Mailing Address - Fax:772-398-9407
Practice Address - Street 1:1701 SE HILLMOOR DR STE 7
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7552
Practice Address - Country:US
Practice Address - Phone:772-398-9808
Practice Address - Fax:772-398-9407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF59353OtherVISTA
FL3682336OtherCIGNA
FLP00271437OtherRR MEDICARE
FL32952OtherBCBS
FLF59353OtherVISTA
FL32952OtherBCBS