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General NPI Number Information
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NPI Number | 1104901586
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Entity Type | Organization
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Legal Business Name | REDI MED OF BONITA SPRINGS LLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9400 BONITA BEACH RD SE SUITE 101
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4515
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Country | US
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Telephone | 239-498-9294
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Fax | 239-498-9179
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Provider Business Mailing Address
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Address Line | 9400 BONITA BEACH RD SE SUITE 101
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4515
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Country | US
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Telephone | 239-498-9294
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Fax | 239-498-9179
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Authorized Official
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Title or Position | OWNER
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Name | SHAWN B MILLER
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Credential | MD
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Telephone | 239-498-9294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME80489
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License Number State | FL
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