Healthcare Provider Details

I. General information

NPI: 1265515779
Provider Name (Legal Business Name): FRANK E CAMPANILE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 METRO PKWY 110
FORT MYERS FL
33912-4327
US

IV. Provider business mailing address

13691 METRO PKWY 110
FORT MYERS FL
33912-4327
US

V. Phone/Fax

Practice location:
  • Phone: 239-225-0333
  • Fax: 239-225-0337
Mailing address:
  • Phone: 239-225-0333
  • Fax: 239-225-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME72108
License Number StateFL

VIII. Authorized Official

Name: FRANK CAMPANILE
Title or Position: OWNER
Credential: MD
Phone: 239-225-0333