Basic Information
| Provider Information | |||||||||
| NPI: | 1437538337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORIO | ||||||||
| FirstName: | NIMA | ||||||||
| MiddleName: | PATEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1821 S STOUGHTON RD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537162257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082606000 | ||||||||
| FaxNumber: | 6082606451 | ||||||||
| Practice Location | |||||||||
| Address1: | 7905 MAIN RD | ||||||||
| Address2: | |||||||||
| City: | MATTITUCK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119521693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312982030 | ||||||||
| FaxNumber: | 9704957425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 75658 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR.0060931 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1437538337 | 05 | WI | MEDICAID |