Provider Demographics
NPI:1104257526
Name:FLORIDA DIGESTIVE HEALTH SPECIALISTS LLP
Entity type:Organization
Organization Name:FLORIDA DIGESTIVE HEALTH SPECIALISTS LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VITO
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DITOMASO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-473-8881
Mailing Address - Street 1:2061 ENGLEWOOD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1749
Mailing Address - Country:US
Mailing Address - Phone:941-473-8881
Mailing Address - Fax:941-475-0801
Practice Address - Street 1:2061 ENGLEWOOD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-1749
Practice Address - Country:US
Practice Address - Phone:941-473-8881
Practice Address - Fax:941-475-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEB572AOtherMEDICARE PTAN