MEDICARE: DR. LOUIS PATRICK RICCI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	LS3412	FL

General Provider Information

NPI Number	:	1114098894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS PATRICK RICCI DO

Provider Business Mailing Address
First Line	:	16476 EDGEMONT DRIVE
Second Line	:
City	:	FORT MEYERS
State	:	FL
Zip	:	33908-6218
Country	:	US
Telephone Number	:	239-437-4081
Fax Number	:	239-437-3732

Provider Business Practice Location Address
First Line	:	16476 EDGEMONT DRIVE
Second Line	:
City	:	FORT MEYERS
State	:	FL
Zip	:	33908-6218
Country	:	US
Telephone Number	:	239-437-4081
Fax Number	:	239-437-3732

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/07/2023

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