Provider Demographics
NPI:1932176096
Name:GI SPECIALISTS PA
Entity Type:Organization
Organization Name:GI SPECIALISTS PA
Other - Org Name:GI SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:P
Authorized Official - Last Name:KINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-454-2800
Mailing Address - Street 1:PO BOX 60157
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-6157
Mailing Address - Country:US
Mailing Address - Phone:239-454-2800
Mailing Address - Fax:239-454-2808
Practice Address - Street 1:8380 RIVERWALK PARK BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8758
Practice Address - Country:US
Practice Address - Phone:239-454-2800
Practice Address - Fax:239-454-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055178207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99240Medicare ID - Type Unspecified