Black, Michael Robert

Black, Michael Robert is an individual health care provider with primary practice located at 12670 Creekside Ln , Fort Myers FL 33919-3370. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Black, Michael Robert can be contacted via phone (239) 482-2663.

Contact Information

Primary practice address
12670 Creekside Ln Fort Myers FL 33919-3370
Phone: (239) 482-2663
Fax: (239) 482-7585
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X PL00000830 Washington
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X PO3431 Florida

Profile Details

NPI number 1851589055
LBN Legal business name Black, Michael Robert
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2007
Last updated May 5th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851589055 NPPES
Florida Other DJ551Y MEDICARE PTAN

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