Healthcare Provider Details

I. General information

NPI: 1306886635
Provider Name (Legal Business Name): CHARLES KILO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 PINE RIDGE RD STE 4
NAPLES FL
34109-2113
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 239-594-5456
  • Fax: 239-592-5456
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-592-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME85812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: