MEDICARE: JOVANIE SERGE KEUSSEU TANKEU MD, MS, MPH, MBA, CH

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	207Q00000X	Family Medicine Physician	ME158173	FL

General Provider Information

NPI Number	:	1326661083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOVANIE SERGE KEUSSEU TANKEU MD, MS, MPH, MBA, CH

Provider Business Mailing Address
First Line	:	14131 METROPOLIS AVE STE 106
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4455
Country	:	US
Telephone Number	:	239-561-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	13141 METROPOLIS AVENUE
Second Line	:	SUITE 106
City	:	FORT MYERS
State	:	FL
Zip	:	33912
Country	:	US
Telephone Number	:	239-561-8880
Fax Number	:	617-362-2906

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

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	05/06/2026

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