MEDICARE: QUILES CRUZ MEDICAL SERVICES PA

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	207R00000X	Internal Medicine Physician	ME105315	FL

General Provider Information

NPI Number	:	1114326774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUILES CRUZ MEDICAL SERVICES PA

Provider Business Mailing Address
First Line	:	8112 FELISA CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-8951
Country	:	US
Telephone Number	:	239-281-9252
Fax Number	:

Provider Business Practice Location Address
First Line	:	8112 FELISA CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-8951
Country	:	US
Telephone Number	:	239-281-9252
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANCISCO J QUILES CRUZ
Credential	:	M.D.
Telephone Number	:	239-281-9252

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	08/20/2014

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