Healthcare Provider Details

I. General information

NPI: 1730638842
Provider Name (Legal Business Name): MILESTONES WELLNESS CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 BROADWAY STE 7
FORT MYERS FL
33901-8193
US

IV. Provider business mailing address

3900 BROADWAY STE 7
FORT MYERS FL
33901-8193
US

V. Phone/Fax

Practice location:
  • Phone: 239-931-0907
  • Fax: 239-309-0330
Mailing address:
  • Phone: 239-931-0907
  • Fax: 239-309-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberOS1417
License Number StateFL

VIII. Authorized Official

Name: DR. LOUIS KOVACS
Title or Position: CHIEF MEDICAL OFFICER
Credential: DO
Phone: 239-931-0907