Healthcare Provider Details

I. General information

NPI: 1508621517
Provider Name (Legal Business Name): NORTHWESTERN MEDICINE FLORIDA MEDICAL GROUP NFP CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 4TH AVE N STE 201
NAPLES FL
34102-5729
US

IV. Provider business mailing address

DEPT 5777
CAROL STREAM IL
60122
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MULLEN
Title or Position: VP, HOSPITAL REVENUE CYCLE, NMHC
Credential:
Phone: 630-938-6076