Healthcare Provider Details

I. General information

NPI: 1164771069
Provider Name (Legal Business Name): ANTHONY J. WILLIAMITIS M D INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 BONITA BEACH RD SE #105
BONITA SPRINGS FL
34135-4280
US

IV. Provider business mailing address

9200 BONITA BEACH RD SE #105
BONITA SPRINGS FL
34135-4280
US

V. Phone/Fax

Practice location:
  • Phone: 239-947-6808
  • Fax: 239-947-9625
Mailing address:
  • Phone: 239-947-6808
  • Fax: 239-947-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0049884
License Number StateFL

VIII. Authorized Official

Name: DR. ANTHONY J WILLIAMITIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-947-6808