Healthcare Provider Details

I. General information

NPI: 1437315033
Provider Name (Legal Business Name): MICHAEL S TSIPURSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28901 TRAILS EDGE BLVD STE 202
BONITA SPRINGS FL
34134-7588
US

IV. Provider business mailing address

28901 TRAILS EDGE BLVD STE 202
BONITA SPRINGS FL
34134-7588
US

V. Phone/Fax

Practice location:
  • Phone: 239-544-3122
  • Fax: 239-544-3128
Mailing address:
  • Phone: 239-544-3122
  • Fax: 239-544-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberFLME131309
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number131309
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number41856
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036128042
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: