Provider Demographics
NPI:1013238153
Name:ADVANCED GYNECOLOGY INC
Entity Type:Organization
Organization Name:ADVANCED GYNECOLOGY INC
Other - Org Name:RAFAEL HACISKI MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HACISKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-692-9699
Mailing Address - Street 1:671 GOODLETTE RD N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5469
Mailing Address - Country:US
Mailing Address - Phone:239-692-9699
Mailing Address - Fax:
Practice Address - Street 1:671 GOODLETTE RD N
Practice Address - Street 2:SUITE 230
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5469
Practice Address - Country:US
Practice Address - Phone:239-692-9699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86280207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty