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General NPI Number Information
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NPI Number | 1942599436
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Entity Type | Organization
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Legal Business Name | ANCHORS AWAY MEDICAL CORP.
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 1495 PINE RIDGE RD. SUITE 4
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City | NAPLES
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State | FL
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Zip | 34109
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Country | US
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Telephone | 239-594-5456
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Fax | 239-592-5456
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Provider Business Mailing Address
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Address Line | 1495 PINE RIDGE RD. SUITE 4
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City | NAPLES
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State | FL
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Zip | 34109
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Country | US
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Telephone | 239-594-5456
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Fax | 239-592-5456
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES J. KILO
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Credential | M.D.
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Telephone | 239-594-5456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME85812
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License Number State | FL
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