MEDICARE: DR. CHARLES KILO 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME85812	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40916F	OTHER	FL	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	84058	OTHER	FL	FL BC

General Provider Information

NPI Number	:	1306886635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES KILO MD

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE
Second Line	:	FL 2
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-2625

Provider Business Practice Location Address
First Line	:	1495 PINE RIDGE RD STE 4
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2113
Country	:	US
Telephone Number	:	239-594-5456
Fax Number	:	239-592-5456

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/19/2019

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