MEDICARE: GI SPECIALISTS 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	207RG0100X	Gastroenterology Physician	ME0055178	FL

General Provider Information

NPI Number	:	1932176096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GI SPECIALISTS PA

Provider Business Mailing Address
First Line	:	PO BOX 60157
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33906-6157
Country	:	US
Telephone Number	:	239-454-2800
Fax Number	:	239-454-2808

Provider Business Practice Location Address
First Line	:	8380 RIVERWALK PARK BLVD
Second Line	:	SUITE 310
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8758
Country	:	US
Telephone Number	:	239-454-2800
Fax Number	:	239-454-2808

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	DR. MUKUND P. KINI
Credential	:	MD
Telephone Number	:	239-454-2800

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	11/01/2007

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