Provider Demographics
NPI:1700803590
Name:GESIOTTO,HENRICKS,KORDONOWY,AND SIMMONS,MDS,PA
Entity Type:Organization
Organization Name:GESIOTTO,HENRICKS,KORDONOWY,AND SIMMONS,MDS,PA
Other - Org Name:INTERNAL MEDICINE OF SOUTHWEST FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HISCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:239-275-7997
Mailing Address - Street 1:6311 S POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4901
Mailing Address - Country:US
Mailing Address - Phone:239-275-0040
Mailing Address - Fax:239-275-7997
Practice Address - Street 1:6311 S POINTE BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4901
Practice Address - Country:US
Practice Address - Phone:239-275-0040
Practice Address - Fax:239-275-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0590OtherUNSPECIFIED