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General NPI Number Information
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NPI Number | 1780983114
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Entity Type | Organization
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Legal Business Name | MATERNAL FETAL MEDICINE OF SOUTHWEST FLORIDA
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Dates
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Enumeration Date | 03/24/2011
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 210 DEL PRADO BLVD SUITE 1
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City | CAPE CORAL
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State | FL
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Zip | 33990-1763
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Country | US
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Telephone | 239-333-1240
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Fax | 239-333-1247
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Provider Business Mailing Address
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Address Line | 8270 COLLEGE PKWY SUITE 205
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City | FT MYERS
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State | FL
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Zip | 33919
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Country | US
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Telephone | 239-333-3826
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Fax | 239-333-0592
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | MARTY MENNA
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Credential |
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Telephone | 239-333-3826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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