Healthcare Provider Details

I. General information

NPI: 1033455910
Provider Name (Legal Business Name): C. KIRK DEMARTINO M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N COLLIER BLVD SUITE 308
MARCO ISLAND FL
34145-2725
US

IV. Provider business mailing address

950 N COLLIER BLVD SUITE 308
MARCO ISLAND FL
34145-2725
US

V. Phone/Fax

Practice location:
  • Phone: 239-642-5552
  • Fax: 239-642-5565
Mailing address:
  • Phone: 239-642-5552
  • Fax: 239-642-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME85819
License Number StateFL

VIII. Authorized Official

Name: DR. CIRO KIRK DEMARTINO
Title or Position: OWNER
Credential: M.D.
Phone: 239-642-5552