Healthcare Provider Details

I. General information

NPI: 1780098087
Provider Name (Legal Business Name): MICHAEL KENNETH HEILAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE STE 709
FORT MYERS FL
33901-5857
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3831
  • Fax: 239-343-2301
Mailing address:
  • Phone: 239-424-1449
  • Fax: 239-343-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME131633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: