Healthcare Provider Details

I. General information

NPI: 1427548304
Provider Name (Legal Business Name): M & H MED HOUSECALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13607 PINE VILLA LN
FORT MYERS FL
33912-1617
US

IV. Provider business mailing address

13607 PINE VILLA LN
FORT MYERS FL
33912-1617
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-0111
  • Fax: 239-772-0267
Mailing address:
  • Phone: 239-772-0111
  • Fax: 239-772-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: ANAND RAJ MAHADEVAN
Title or Position: OWNER
Credential: MD
Phone: 239-772-0111