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General NPI Number Information
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NPI Number | 1467140228
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Entity Type | Organization
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Legal Business Name | AXEL MEDICAL GROUP LLC
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Dates
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Enumeration Date | 04/28/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 6811 PORTO FINO CIR
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City | FORT MYERS
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State | FL
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Zip | 33912-4354
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Country | US
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Telephone | 239-208-6648
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Fax | 855-462-3008
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Provider Business Mailing Address
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Address Line | 4820 GRIFFIN BLVD
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City | FORT MYERS
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State | FL
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Zip | 33908-2016
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Country | US
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Telephone | 239-208-6648
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Fax | 855-462-3008
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | JESSELL LLORENTE
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Credential |
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Telephone | 239-223-8129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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