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Individual

ROWELLA LICUP SIRBILADZE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
8960 COLONIAL CENTER DR STE 202, FORT MYERS, FL 33905-7810
(239) 343-9646
(239) 343-9681
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9646
(239) 343-9681

Taxonomy

Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
ME151358
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
114292600
FL
Enumeration date
11/30/2007
Last updated
07/15/2022
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