Basic Information
Provider Information
NPI: 1003142738
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GELLI
FirstName: SREEDHAR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 2147
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339022147
CountryCode: US
TelephoneNumber: 2394241449
FaxNumber:  
Practice Location
Address1: 2776 CLEVELAND AVE
Address2:  
City: FORT MYERS
State: FL
PostalCode: 33901
CountryCode: US
TelephoneNumber: 2394241449
FaxNumber: 2394241421
Other Information
ProviderEnumerationDate: 10/30/2009
LastUpdateDate: 08/02/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XME106612FLY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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