Healthcare Provider Details

I. General information

NPI: 1043775232
Provider Name (Legal Business Name): ANCURAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 STRINGFELLOW RD STE 50
BOKEELIA FL
33922-3232
US

IV. Provider business mailing address

2838 SW 30TH ST
CAPE CORAL FL
33914-2000
US

V. Phone/Fax

Practice location:
  • Phone: 833-742-6276
  • Fax: 833-895-9833
Mailing address:
  • Phone: 833-742-6276
  • Fax: 833-895-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL LEE WILBURN HANLEY
Title or Position: MEMBER
Credential: MD
Phone: 833-742-6276