Provider Demographics
NPI:1427357854
Name:MATERNAL FETAL MEDINE OF SW FLORDIA
Entity type:Organization
Organization Name:MATERNAL FETAL MEDINE OF SW FLORDIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-333-3826
Mailing Address - Street 1:8270 COLLEGE PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-333-3826
Mailing Address - Fax:239-333-0592
Practice Address - Street 1:26800 S. TAMIAMI TR
Practice Address - Street 2:SUITE 230
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4390
Practice Address - Country:US
Practice Address - Phone:239-254-8884
Practice Address - Fax:239-254-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty