MEDICARE: NOVARE MEDICAL AND WELLNESS INC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1326936329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVARE MEDICAL AND WELLNESS INC

Provider Business Mailing Address
First Line	:	15947 TROPICAL BREEZE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-1744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15880 SUMMERLIN RD STE 114
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9614
Country	:	US
Telephone Number	:	312-391-4888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IVAN BRACIC
Credential	:
Telephone Number	:	312-391-4888

Provider Enumeration Date	:	06/26/2025
Last Update Date	:	06/26/2025

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