MEDICARE: HEIDI M EISELE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1497045785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI M EISELE

Provider Business Mailing Address
First Line	:	2506 2ND ST
Second Line	:	SUITE 105
City	:	FORT MYERS
State	:	FL
Zip	:	33901-2500
Country	:	US
Telephone Number	:	239-334-9555
Fax Number	:	239-334-2439

Provider Business Practice Location Address
First Line	:	2506 2ND ST
Second Line	:	SUITE 105
City	:	FORT MYERS
State	:	FL
Zip	:	33901-2500
Country	:	US
Telephone Number	:	239-334-9555
Fax Number	:	239-334-2439

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

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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Directions to “ HEIDI M EISELE ” Practice Location

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