MEDICARE: GAIL M SANTUCCI MD

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	2085R0202X	Diagnostic Radiology Physician	35086020	OH
2	2085R0202X	Diagnostic Radiology Physician	ME97249	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14879	OTHER	FL	BCBS FL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235187808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL M SANTUCCI MD

Provider Business Mailing Address
First Line	:	8791 CONFERENCE DR
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5822
Country	:	US
Telephone Number	:	239-938-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	8791 CONFERENCE DR
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33919-5822
Country	:	US
Telephone Number	:	239-938-3506
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	04/09/2014

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Directions to “ GAIL M SANTUCCI MD” Practice Location

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