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General NPI Number Information
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NPI Number | 1114178340
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Entity Type | Organization
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Legal Business Name | DEAN L RACKLEFF MD PA
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 9400 BONITA BEACH RD SE STE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4520
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Country | US
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Telephone | 239-455-9946
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Fax | 239-455-9947
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Provider Business Mailing Address
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Address Line | 9400 BONITA BEACH ROAD SUITE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135
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Country | US
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Telephone | 239-455-9946
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Fax | 239-455-9947
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEAN LAWRENCE RACKLEFF
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Credential | MD
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Telephone | 239-455-9946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME0069187
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License Number State | FL
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