MEDICARE: ANGEL PIETRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME48879	FL

General Provider Information

NPI Number	:	1083615108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL PIETRI M.D.

Provider Business Mailing Address
First Line	:	12645 NEW BRITTANY BLVD BLDG 15
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-277-9377
Fax Number	:	239-277-3292

Provider Business Practice Location Address
First Line	:	12645 NEW BRITTANY BLVD BLDG 15
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3631
Country	:	US
Telephone Number	:	239-277-9377
Fax Number	:	239-277-3292

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	11/06/2007

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