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General NPI Number Information
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NPI Number | 1619216314
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CONSULTANTS OF SOUTHWEST FLORIDA, PL
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 7964 SUMMERLIN LAKES DR
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City | FORT MYERS
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State | FL
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Zip | 33907-1816
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Country | US
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Telephone | 239-333-1777
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Fax | 239-333-1169
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Provider Business Mailing Address
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Address Line | 23 BARKLEY CIR
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City | FORT MYERS
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State | FL
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Zip | 33907-7531
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Country | US
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Telephone | 605-988-4883
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. VELIMIR A MICOVIC
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Credential | MD
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Telephone | 239-333-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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