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NPI Code Detail

MEDICARE: DR. CHARLES J HAVEL JR. M.D.

MEDICARE: DR. CHARLES J HAVEL JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PP0204XPediatric Emergency Medicine (Emergency Medicine) Physician31212WI
2207P00000XEmergency Medicine PhysicianME99856FL
3207PP0204XPediatric Emergency Medicine (Emergency Medicine) PhysicianIL

General Provider Information

NPI Number : 1558358143
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES J HAVEL JR. M.D.
Provider Business Mailing Address
First Line : 1323 PAR VIEW DR
Second Line :
City : SANIBEL
State : FL
Zip : 33957-6409
Country : US
Telephone Number : 239-395-1044
Fax Number :
Provider Business Practice Location Address
First Line : 1500 LEE BLVD
Second Line :
City : LEHIGH ACRES
State : FL
Zip : 33936-4835
Country : US
Telephone Number : 239-368-4110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2005
Last Update Date : 02/01/2008

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