Healthcare Provider Details

I. General information

NPI: 1538166392
Provider Name (Legal Business Name): LUIS A GHIGLINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5962 BERRYHILL RD
MILTON FL
32570-4009
US

IV. Provider business mailing address

5962 BERRYHILL RD
MILTON FL
32570-4009
US

V. Phone/Fax

Practice location:
  • Phone: 850-983-3700
  • Fax: 850-983-0970
Mailing address:
  • Phone: 850-983-3700
  • Fax: 850-983-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: