Healthcare Provider Details

I. General information

NPI: 1659365435
Provider Name (Legal Business Name): MICHAEL LEE NOVOTNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 SUMMERLIN LAKES DR STE 100
FORT MYERS FL
33907-1849
US

IV. Provider business mailing address

8010 SUMMERLIN LAKES DR STE 100
FORT MYERS FL
33907-1849
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-1767
  • Fax: 239-939-5895
Mailing address:
  • Phone: 239-939-1767
  • Fax: 239-939-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME80304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: