Provider Demographics
NPI:1316920259
Name:MCCLEOD, MICHAEL J (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCCLEOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3224
Practice Address - Street 1:8981 COLONIAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7816
Practice Address - Country:US
Practice Address - Phone:239-938-0800
Practice Address - Fax:239-938-0890
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2022-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5832207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
830004835OtherRAILROAD MEDICARE
FL063151500Medicaid
FL063151500Medicaid
FL80312WMedicare PIN