Healthcare Provider Details

I. General information

NPI: 1235212267
Provider Name (Legal Business Name): RAFAEL CHRISTOPHER HACISKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 GOODLETTE RD N SUITE 230
NAPLES FL
34102-5469
US

IV. Provider business mailing address

671 GOODLETTE RD N SUITE 230
NAPLES FL
34102-5469
US

V. Phone/Fax

Practice location:
  • Phone: 239-692-9699
  • Fax:
Mailing address:
  • Phone: 239-692-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME86280
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME86280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: