Healthcare Provider Details

I. General information

NPI: 1356858518
Provider Name (Legal Business Name): GILL MD INSTITUTE OF AESTHETIC PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 09/15/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 AIRPORT ROAD N.
NAPLES FL
34105
US

IV. Provider business mailing address

6610 WILLOW PARK DR STE 104
NAPLES FL
34109-9014
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-8000
  • Fax: 239-596-4015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KIRANJEET GILL
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 239-596-8000