Healthcare Provider Details

I. General information

NPI: 1821056540
Provider Name (Legal Business Name): JACEK HENRYK PIETA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 MEDICAL BLVD STE 101
NAPLES FL
34110-1426
US

IV. Provider business mailing address

311 9TH ST. N. SUITE 304
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8250
  • Fax: 239-624-8251
Mailing address:
  • Phone: 239-624-8250
  • Fax: 239-624-8251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME153904
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036087837
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036087837
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME153904
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036087837
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME153904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: