Provider Demographics
NPI:1780687467
Name:DEMARTINO, CIRO KIRK (MD)
Entity Type:Individual
Prefix:DR
First Name:CIRO
Middle Name:KIRK
Last Name:DEMARTINO
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 1:950 N COLLIER BLVD
Mailing Address - Street 2:STE 308
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-2722
Mailing Address - Country:US
Mailing Address - Phone:239-642-5552
Mailing Address - Fax:239-642-5565
Practice Address - Street 1:950 N COLLIER BLVD
Practice Address - Street 2:STE 308
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-2722
Practice Address - Country:US
Practice Address - Phone:239-642-5552
Practice Address - Fax:239-642-5565
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 85819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79208OtherBLUE CROSS
FL79208Medicare ID - Type UnspecifiedMEDICARE
FLH91273Medicare UPIN