Healthcare Provider Details

I. General information

NPI: 1417346388
Provider Name (Legal Business Name): HOUSECALLS MD SWFL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 BLUE CYPRESS LAKE CT
CAPE CORAL FL
33909-2912
US

IV. Provider business mailing address

2656 BLUE CYPRESS LAKE CT
CAPE CORAL FL
33909-2912
US

V. Phone/Fax

Practice location:
  • Phone: 239-410-3894
  • Fax: 239-772-0267
Mailing address:
  • Phone: 239-410-3894
  • Fax: 239-772-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: STACY ANN HERMINA
Title or Position: VICE PRESIDENT
Credential:
Phone: 239-410-3894