Healthcare Provider Details

I. General information

NPI: 1114098894
Provider Name (Legal Business Name): LOUIS PATRICK RICCI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16476 EDGEMONT DRIVE
FORT MEYERS FL
33908-6218
US

IV. Provider business mailing address

16476 EDGEMONT DRIVE
FORT MEYERS FL
33908-6218
US

V. Phone/Fax

Practice location:
  • Phone: 239-437-4081
  • Fax: 239-437-3732
Mailing address:
  • Phone: 239-437-4081
  • Fax: 239-437-3732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLS3412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: