Provider Demographics
NPI:1205449790
Name:ELITE UROLOGY OF SOUTHWEST FLORIDA LLC
Entity type:Organization
Organization Name:ELITE UROLOGY OF SOUTHWEST FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ERCOLANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-275-5777
Mailing Address - Street 1:401 COMMERCIAL CT STE E
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1652
Mailing Address - Country:US
Mailing Address - Phone:941-260-4440
Mailing Address - Fax:941-260-4441
Practice Address - Street 1:401 COMMERCIAL CT STE E
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1652
Practice Address - Country:US
Practice Address - Phone:941-260-4440
Practice Address - Fax:941-260-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty