Healthcare Provider Details

I. General information

NPI: 1700860889
Provider Name (Legal Business Name): MICHAEL A JAINDL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LEE BLVD STE 2350
LEHIGH ACRES FL
33936-4851
US

IV. Provider business mailing address

1530 LEE BLVD STE 2350
LEHIGH ACRES FL
33936-4851
US

V. Phone/Fax

Practice location:
  • Phone: 239-674-7345
  • Fax: 239-491-2347
Mailing address:
  • Phone: 239-674-7345
  • Fax: 239-674-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME 108882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: