Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2022-05-12
- Last updated
- 2026-07-31
Licenses
- License OH
- 34.016894
- License FL
- OS23157
Location
- Practice location
- 2776 CLEVELAND AVE
- City
- FORT MYERS FL
- Postal code
- 339015864
- Phone
- 239-343-1614
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.