MEDICARE: ASSOCIATES IN DIGESTIVE HEALTH LLC

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	207RG0100X	Gastroenterology Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7519547	OTHER	FL	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	45406	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790868099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATES IN DIGESTIVE HEALTH LLC

Provider Business Mailing Address
First Line	:	625 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2667
Country	:	US
Telephone Number	:	239-772-3636
Fax Number	:	239-772-5073

Provider Business Practice Location Address
First Line	:	625 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2667
Country	:	US
Telephone Number	:	239-772-3636
Fax Number	:	239-772-5073

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	KRIS BREYLEY
Credential	:	RN
Telephone Number	:	239-772-3636

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/21/2022

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Directions to “ASSOCIATES IN DIGESTIVE HEALTH LLC ” Practice Location

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