1275689762 NPI number — PAUL J MISKE PH D LLC

Table of content: (NPI 1275689762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275689762 NPI number — PAUL J MISKE PH D LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL J MISKE PH D LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275689762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2045 SE 28TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33904-3284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-242-0588
Provider Business Mailing Address Fax Number:
239-242-9945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 EL DORADO PKWY W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33914-7251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-242-0588
Provider Business Practice Location Address Fax Number:
239-242-9945
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MISKE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
239-242-0588

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY 6267 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54611 . This is a "BCBC OF FL PROVIDER NUMBE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com