MEDICARE: MEDICAL INNOVATIONS 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1457670572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL INNOVATIONS INC

Provider Business Mailing Address
First Line	:	6158 LAKE FRONT DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4432
Country	:	US
Telephone Number	:	239-218-7337
Fax Number	:	239-432-9546

Provider Business Practice Location Address
First Line	:	6158 LAKE FRONT DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4432
Country	:	US
Telephone Number	:	239-218-7337
Fax Number	:	239-432-9546

Authorized Official
Title or Position	:	SOLE OWNER
Name	:	MS. DAGMAR SULLIVAN
Credential	:	ARNP
Telephone Number	:	239-218-7337

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	05/28/2010

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Directions to “MEDICAL INNOVATIONS INC ” Practice Location

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