=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962794289
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA INCISIONLESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2011
-----------------------------------------------------
Last Update Date | 05/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4881 PALM BEACH BLVD SUITE 100
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33905-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-433-3504
-----------------------------------------------------
Fax | 239-693-7369
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4881 PALM BEACH BLVD SUITE 100
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33905-3217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-433-3504
-----------------------------------------------------
Fax | 239-693-7369
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SURGEON
-----------------------------------------------------
Name | DR. PETER MICHAEL DENK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-433-3504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------