Healthcare Provider Details

I. General information

NPI: 1659389948
Provider Name (Legal Business Name): DAVID A MACKOUL, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SE 16TH PL
CAPE CORAL FL
33990-1329
US

IV. Provider business mailing address

206 SE 16TH PL
CAPE CORAL FL
33990-1329
US

V. Phone/Fax

Practice location:
  • Phone: 239-829-1747
  • Fax: 239-573-2006
Mailing address:
  • Phone: 239-829-1747
  • Fax: 239-573-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID MACKOUL
Title or Position: PRESIDENT
Credential: MD
Phone: 239-573-2001