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General NPI Number Information
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NPI Number | 1275689762
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Entity Type | Organization
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Legal Business Name | PAUL J MISKE PH D LLC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 916 EL DORADO PKWY W
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City | CAPE CORAL
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State | FL
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Zip | 33914-7251
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Country | US
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Telephone | 239-242-0588
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Fax | 239-242-9945
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Provider Business Mailing Address
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Address Line | 2045 SE 28TH ST
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City | CAPE CORAL
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State | FL
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Zip | 33904-3284
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Country | US
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Telephone | 239-242-0588
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Fax | 239-242-9945
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL J MISKE
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Credential | PH D
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Telephone | 239-242-0588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 6267
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License Number State | FL
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