Basic Information
| Provider Information | |||||||||
| NPI: | 1003807082 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZITTEL | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | ME67849 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 207V00000X | ME67849 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 379946800 | 05 | FL | MEDICAID |