Healthcare Provider Details

I. General information

NPI: 1316920259
Provider Name (Legal Business Name): MICHAEL J. MCCLEOD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8981 COLONIAL CENTER DR
FORT MYERS FL
33905-7816
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 239-938-0800
  • Fax: 239-938-0890
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberOS5832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: