Healthcare Provider Details

I. General information

NPI: 1801155064
Provider Name (Legal Business Name): SPENCER K MICHALKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8925 COLONIAL CENTER DR STE 1000
FORT MYERS FL
33905-7813
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-396-8930
  • Fax: 239-396-8932
Mailing address:
  • Phone: 239-396-8930
  • Fax: 239-396-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number62006
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number13930346-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME173641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: