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General NPI Number Information
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NPI Number | 1326661083
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Entity Type | Individual
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Provider Name | JOVANIE SERGE KEUSSEU TANKEU MD, MS, MPH, MBA, CH
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Gender | Male
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 13141 METROPOLIS AVENUE SUITE 106
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City | FORT MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-561-8880
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Fax | 617-362-2906
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Provider Business Mailing Address
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Address Line | 14131 METROPOLIS AVE STE 106
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City | FORT MYERS
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State | FL
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Zip | 33912-4455
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Country | US
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Telephone | 239-561-8880
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME158173
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License Number State | FL
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