MEDICARE: DIEGO JOSE HEREDIA VINTIMILLA M.D.

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	ME144293	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

General Provider Information

NPI Number	:	1831321942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIEGO JOSE HEREDIA VINTIMILLA M.D.

Provider Business Mailing Address
First Line	:	3245 HEALTH DR STE 100
Second Line	:
City	:	GRANGER
State	:	IN
Zip	:	46530-1380
Country	:	US
Telephone Number	:	574-647-1840
Fax Number	:	574-237-6069

Provider Business Practice Location Address
First Line	:	311 9TH ST N STE 304
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5887
Country	:	US
Telephone Number	:	239-624-8250
Fax Number	:	239-624-8171

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

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	09/11/2025

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