Healthcare Provider Details

I. General information

NPI: 1245464130
Provider Name (Legal Business Name): EDUARDO MANUEL MARISTANY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 TAMIAMI TRL N STE 103
NAPLES FL
34102-8143
US

IV. Provider business mailing address

625 TAMIAMI TRL N STE 103
NAPLES FL
34102-8143
US

V. Phone/Fax

Practice location:
  • Phone: 239-212-2022
  • Fax: 239-567-3604
Mailing address:
  • Phone: 239-212-2022
  • Fax: 239-567-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME118407
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME118407
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number068451
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number068451
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: