Provider Demographics
NPI:1295926277
Name:GITTLEMAN, ALICIA EVE (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:EVE
Last Name:GITTLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3343 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8002
Practice Address - Country:US
Practice Address - Phone:561-795-9845
Practice Address - Fax:561-795-8791
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY247489-12085R0001X
FLME1160782085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01568228OtherRR MEDICARE
FL9002974OtherCIGNA
NY01362743Medicaid
FL14362OtherDIMENSION
FLP1041372OtherFREEDOM
FL387763OtherAVMED
FL619271OtherWELLCARE
FL9134329OtherAETNA
FLUKB3COtherBCBS
FLP975930OtherOPTIMUM
FL9134329OtherAETNA
FL9002974OtherCIGNA