MEDICARE: HOOSHANG MICHAEL BOLOOKI 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	207RC0000X	Cardiovascular Disease Physician	49677	MN
2	207RC0000X	Cardiovascular Disease Physician	ME107586	FL
3	207R00000X	Internal Medicine Physician	35088092	OH

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	:	1962515924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOOSHANG MICHAEL BOLOOKI MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9700
Fax Number	:	239-343-9699

Provider Business Practice Location Address
First Line	:	8960 COLONIAL CENTER DR
Second Line	:	SUITE 302
City	:	FORT MYERS
State	:	FL
Zip	:	33905
Country	:	US
Telephone Number	:	239-343-9700
Fax Number	:	239-343-9699

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	06/15/2026

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Directions to “ HOOSHANG MICHAEL BOLOOKI MD” Practice Location

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