Healthcare Provider Details

I. General information

NPI: 1073626198
Provider Name (Legal Business Name): DINA ANTOUN BADRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9160 GALLERIA CT
NAPLES FL
34109-4343
US

IV. Provider business mailing address

15539 MONTEROSSO LN #201
NAPLES FL
34110-2742
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-8787
  • Fax: 239-514-1965
Mailing address:
  • Phone: 239-514-8787
  • Fax: 239-514-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065421
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: