Provider Demographics
NPI:1982680179
Name:SEDILLO, GINO J (MD)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:J
Last Name:SEDILLO
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 1:2210 61ST ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5527
Mailing Address - Country:US
Mailing Address - Phone:941-747-8789
Mailing Address - Fax:
Practice Address - Street 1:2210 61ST ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5527
Practice Address - Country:US
Practice Address - Phone:941-747-8789
Practice Address - Fax:941-747-8711
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076343207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10720565OtherCAQH
FL5960298OtherAETNA PIN
FL0033UOtherBCBS OF FL
FL2563861OtherCIGNA
FL259743OtherAVMED
FLP510837OtherOPTIMUM MCR HMO
FLP103504OtherFREEDOM MCR HMO
FL22578OtherWELLCARE/MEDICARE PLAN ONLY
FL2563861OtherCIGNA
FLP510837OtherOPTIMUM MCR HMO