MEDICARE: DANIELE MEDICAL EQUIPMENT LLC

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1922343599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELE MEDICAL EQUIPMENT LLC

Provider Business Mailing Address
First Line	:	4300 FORD ST. EXT
Second Line	:	UNIT 101
City	:	FT. MYERS
State	:	FL
Zip	:	33916
Country	:	US
Telephone Number	:	239-936-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 FORD ST. EXT
Second Line	:	UNIT 101
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9317
Country	:	US
Telephone Number	:	239-936-7070
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. DOMINIC J DANIELE
Credential	:
Telephone Number	:	239-936-7070

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	12/07/2012

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