Healthcare Provider Details

I. General information

NPI: 1902008170
Provider Name (Legal Business Name): WILFREDO BLASINI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 WESTLINKS DR UNIT 3
FORT MYERS FL
33913-8615
US

IV. Provider business mailing address

PO BOX 102222 ATTN: CREDENTIAL DEPT
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-9622
  • Fax: 239-768-5297
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number18357
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberME102349
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number18357
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME102349
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18357
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME102349
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberME102349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: