1821343229 NPI number — LEONID B TROST MD LLC

Table of content: (NPI 1821343229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821343229 NPI number — LEONID B TROST MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEONID B TROST MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821343229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9400 GLADIOLUS DR
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-6699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-482-7546
Provider Business Mailing Address Fax Number:
239-243-8648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9400 GLADIOLUS DR
Provider Second Line Business Practice Location Address:
STE 320
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33908-6699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-482-7546
Provider Business Practice Location Address Fax Number:
239-243-8648
Provider Enumeration Date:
07/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TROST
Authorized Official First Name:
LEONID
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
239-482-7546

Provider Taxonomy Codes

  • Taxonomy code: 207ND0101X , with the licence number:  ME100046 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ME100046 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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