Healthcare Provider Details

I. General information

NPI: 1639172588
Provider Name (Legal Business Name): MICHAEL C. HANUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 COLLIER BLVD STE 102
NAPLES FL
34114-3550
US

IV. Provider business mailing address

8625 COLLIER BLVD STE 102
NAPLES FL
34114-3550
US

V. Phone/Fax

Practice location:
  • Phone: 239-429-0100
  • Fax: 239-421-8209
Mailing address:
  • Phone: 239-429-0100
  • Fax: 239-421-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME82215
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME0082215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: