Healthcare Provider Details

I. General information

NPI: 1245817006
Provider Name (Legal Business Name): JESSE LEE MCILWAINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH ST N STE 201
NAPLES FL
34102-5887
US

IV. Provider business mailing address

350 7TH ST N
NAPLES FL
34102-5754
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0030
  • Fax:
Mailing address:
  • Phone: 239-624-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS22639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: