Healthcare Provider Details

I. General information

NPI: 1922248715
Provider Name (Legal Business Name): CUTIS DIAGNOSTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 METROPOLIS AVENUE
FORT MYERS FL
33912
US

IV. Provider business mailing address

13691 METROPOLIS AVENUE
FORT MYERS FL
33912
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-3376
  • Fax: 239-561-3020
Mailing address:
  • Phone: 239-561-3376
  • Fax: 239-561-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN A BADIA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 239-425-6805