=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093528739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CPERAGLIE MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 339 CYPRESS PKWY STE 110
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34759-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-922-3424
-----------------------------------------------------
Fax | 877-882-8238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1314 CELEBRATION AVE
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34747-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-922-3424
-----------------------------------------------------
Fax | 877-882-8238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CESARE P PERAGLIE
-----------------------------------------------------
Credential | MD FACS FASCRS
-----------------------------------------------------
Telephone | 407-922-3424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208C00000X
-----------------------------------------------------
Taxonomy Name | Colon & Rectal Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------