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General NPI Number Information
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NPI Number | 1639125735
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGIC & COSMETIC INSTITUTE INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 90 CYPRESS WAY E SUITE 50
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City | NAPLES
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State | FL
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Zip | 34110-9275
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Country | US
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Telephone | 239-598-3200
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Fax | 239-598-0233
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Provider Business Mailing Address
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Address Line | 90 CYPRESS WAY E SUITE 50
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City | NAPLES
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State | FL
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Zip | 34110-9275
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Country | US
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Telephone | 239-598-3200
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Fax | 239-598-0233
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Authorized Official
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Title or Position | OWNER
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Name | SRDJAN PRODANOVICH
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Credential | MD
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Telephone | 239-598-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME95851
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License Number State |
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