Healthcare Provider Details

I. General information

NPI: 1578083259
Provider Name (Legal Business Name): ERIC MCKEEVER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTHCARE WAY
NORTH VENICE FL
34275-3669
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-261-2700
  • Fax: 941-261-0918
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101023431
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberOS19181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: