Provider Demographics
NPI:1881652584
Name:GINO VITIELLO, M.D., P.A.
Entity Type:Organization
Organization Name:GINO VITIELLO, M.D., P.A.
Other - Org Name:COMPREHENSIVE CARDIOVASCULAR CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINO
Authorized Official - Middle Name:N
Authorized Official - Last Name:VITIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-255-2500
Mailing Address - Street 1:9299 SW 152ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1775
Mailing Address - Country:US
Mailing Address - Phone:305-255-2500
Mailing Address - Fax:305-255-5395
Practice Address - Street 1:9299 SW 152ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-255-2500
Practice Address - Fax:305-255-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 141598207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45885Medicare ID - Type Unspecified