Provider Demographics
NPI:1992110878
Name:FRANK P. CAMPISI, M.D, ,PA
Entity type:Organization
Organization Name:FRANK P. CAMPISI, M.D, ,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAMPISI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-745-3138
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0608
Mailing Address - Country:US
Mailing Address - Phone:407-619-1942
Mailing Address - Fax:
Practice Address - Street 1:825 OAKLEY SEAVER DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:407-745-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032625208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049921800Medicaid
FL049921800Medicaid
FL47553XMedicare PIN