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NPI Code Detail

MEDICARE: AXEL HEALTH PRIMARY CARE LLC

MEDICARE: AXEL HEALTH PRIMARY CARE LLC
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
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME91067OTHERMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700463643
Entity Type Code : Organization
Provider Name (Legal Business Name) : AXEL HEALTH PRIMARY CARE LLC
Provider Business Mailing Address
First Line : 6811 PORTO FINO CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-4354
Country : US
Telephone Number : 239-208-6648
Fax Number : 239-931-0221
Provider Business Practice Location Address
First Line : 6811 PORTO FINO CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-4354
Country : US
Telephone Number : 239-208-6648
Fax Number : 239-931-0221
Authorized Official
Title or Position : CEO
Name : SUMEET SHETTY
Credential : MD
Telephone Number : 239-208-6648
Provider Enumeration Date : 03/26/2021
Last Update Date : 08/10/2023

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Directions to “AXEL HEALTH PRIMARY CARE LLC ” Practice Location

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