Healthcare Provider Details

I. General information

NPI: 1003294604
Provider Name (Legal Business Name): MICAH BISHOP DVM, DACVIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 MARKET ST SUITE 1
NAPLES FL
34112-3444
US

IV. Provider business mailing address

10130 MARKET ST SUITE 1
NAPLES FL
34112-3444
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-0480
  • Fax: 239-263-0488
Mailing address:
  • Phone: 239-263-0480
  • Fax: 239-263-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVM12748
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number10569
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: