Provider Demographics
NPI:1265515779
Name:FRANK E CAMPANILE MD PA
Entity type:Organization
Organization Name:FRANK E CAMPANILE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPANILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-225-0333
Mailing Address - Street 1:13691 METRO PKWY
Mailing Address - Street 2:110
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4327
Mailing Address - Country:US
Mailing Address - Phone:239-225-0333
Mailing Address - Fax:239-225-0337
Practice Address - Street 1:13691 METRO PKWY
Practice Address - Street 2:110
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4327
Practice Address - Country:US
Practice Address - Phone:239-225-0333
Practice Address - Fax:239-225-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72108208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE8326Medicare PIN
K4624Medicare PIN