MEDICARE: SPENCER K MICHALKE M.D.

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	208200000X	Plastic Surgery Physician	62006	AZ
2	208200000X	Plastic Surgery Physician	13930346-1205	UT
3	2086S0122X	Plastic and Reconstructive Surgery Physician	ME173641	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

General Provider Information

NPI Number	:	1801155064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER K MICHALKE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-396-8930
Fax Number	:	239-396-8932

Provider Business Practice Location Address
First Line	:	8925 COLONIAL CENTER DR STE 1000
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-7813
Country	:	US
Telephone Number	:	239-396-8930
Fax Number	:	239-396-8932

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

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	06/04/2026

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Directions to “ SPENCER K MICHALKE M.D.” Practice Location

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