MEDICARE: MICHAEL LACORTE MD

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	2080P0202X	Pediatric Cardiology Physician	ME111609	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1710082821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LACORTE MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-7490
Fax Number	:	239-343-5032

Provider Business Practice Location Address
First Line	:	16281 BASS RD STE 304
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-9687
Country	:	US
Telephone Number	:	239-343-7490
Fax Number	:	239-343-5032

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/29/2021

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Directions to “ MICHAEL LACORTE MD” Practice Location

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