Healthcare Provider Details

I. General information

NPI: 1699752436
Provider Name (Legal Business Name): DAVID GEORGE CISLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13823 TAMIAMI TRL
NORTH PORT FL
34287-2069
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 941-888-0770
  • Fax: 941-888-0778
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS5665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: