MEDICARE: MR. MICHAEL A. ESTES MS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AL00000314	FL

General Provider Information

NPI Number	:	1255385092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL A. ESTES MS, ATC

Provider Business Mailing Address
First Line	:	9217 TANGELO BLVD
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33912-3759
Country	:	US
Telephone Number	:	239-433-0243
Fax Number	:

Provider Business Practice Location Address
First Line	:	FLORIDA GULF COAST UNIVERSITY
Second Line	:	10501 FGCU BLVD. SOUTH
City	:	FT MYERS
State	:	FL
Zip	:	33965-0001
Country	:	US
Telephone Number	:	239-590-7006
Fax Number	:	239-590-7398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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