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General NPI Number Information
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NPI Number | 1538453618
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Entity Type | Organization
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Legal Business Name | PELVIC PAIN DIAGNOSTIC AND TREATMENT CENTER
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 1918 ROBINHOOD ST
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City | SARASOTA
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State | FL
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Zip | 34231-3620
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Country | US
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Telephone | 985-630-0498
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Fax | 941-538-9415
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Provider Business Mailing Address
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Address Line | 1918 ROBINHOOD ST
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City | SARASOTA
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State | FL
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Zip | 34231-3620
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Country | US
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Telephone | 985-630-0498
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Fax | 941-538-9415
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Authorized Official
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Title or Position | SOLE PROPRIETOR/OWNER
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Name | DR. GERARD MICHAEL DILEO
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Credential | M.D.
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Telephone | 985-373-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME95062
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License Number State | FL
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