Healthcare Provider Details

I. General information

NPI: 1497861868
Provider Name (Legal Business Name): LUIGI QUERUSIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH STREET NORTH SUITE 308
NAPLES FL
34102
US

IV. Provider business mailing address

311 TAMIAMI TRL N STE 308
NAPLES FL
34102-5889
US

V. Phone/Fax

Practice location:
  • Phone: 239-417-0085
  • Fax: 239-417-0087
Mailing address:
  • Phone: 239-514-0459
  • Fax: 239-514-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME103596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: