Basic Information
Provider Information
NPI: 1003807082
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZITTEL
FirstName: GREGORY
MiddleName: A.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 719 RODEL CV STE 1015
Address2:  
City: LAKE MARY
State: FL
PostalCode: 327465716
CountryCode: US
TelephoneNumber: 4073023133
FaxNumber: 4073304690
Practice Location
Address1: 719 RODEL CV STE 1015
Address2:  
City: LAKE MARY
State: FL
PostalCode: 327465716
CountryCode: US
TelephoneNumber: 4073023133
FaxNumber: 4073304690
Other Information
ProviderEnumerationDate: 10/31/2005
LastUpdateDate: 08/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XME67849FLY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 
207VG0400XME67849FLN Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology

ID Information
IDTypeStateIssuerDescription
37994680005FL MEDICAID


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