Provider Demographics
NPI:1124089784
Name:INCORVATI, DENNIS L (DO)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:INCORVATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-0550
Mailing Address - Fax:239-343-4013
Practice Address - Street 1:13340 METRO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-4818
Practice Address - Country:US
Practice Address - Phone:239-343-0550
Practice Address - Fax:239-343-4013
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207952207RC0000X
FLOS11408207RC0000X
GA50527207UN0902X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019260900Medicaid
GA000919124RMedicaid
GA000919124QMedicaid
GAF13483Medicare UPIN
GA000919124TMedicaid
GA202I062492Medicare PIN
GA202I068438Medicare PIN