MEDICARE: ANCHORS AWAY MEDICAL CORP

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	ME85812	FL

General Provider Information

NPI Number	:	1588963425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHORS AWAY MEDICAL CORP

Provider Business Mailing Address
First Line	:	1495 PINE RIDGE RD
Second Line	:	SUITE 4
City	:	NAPLES
State	:	FL
Zip	:	34109-2113
Country	:	US
Telephone Number	:	239-594-5456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 PINE RIDGE RD
Second Line	:	SUITE 4
City	:	NAPLES
State	:	FL
Zip	:	34109-2113
Country	:	US
Telephone Number	:	239-594-5456
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES KILO
Credential	:	MD
Telephone Number	:	239-294-5456

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	07/01/2011

Similar Medicare Providers

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Practice Location Address:

1495 PINE RIDGE RD STE 4
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Directions to “ANCHORS AWAY MEDICAL CORP ” Practice Location

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