Healthcare Provider Details

I. General information

NPI: 1770631475
Provider Name (Legal Business Name): MICHAL NAWALANY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 CREEKSIDE LN STE 301
FORT MYERS FL
33919-3356
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3780
  • Fax: 239-343-3781
Mailing address:
  • Phone: 239-343-9960
  • Fax: 239-343-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number51214
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME154691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: