Provider Demographics
NPI:1588875678
Name:MUHLETALER, FRED (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:MUHLETALER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:MUHLETALER-MAGGIOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3347 STATE ROAD 7
Practice Address - Street 2:SUITE 101
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8095
Practice Address - Country:US
Practice Address - Phone:561-790-2111
Practice Address - Fax:561-296-0436
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP1033151OtherFREEDOM
FLRPK0TOtherBCBS
FLP969344OtherOPTIMUM
FL1233328OtherWELLCARE
FL14386OtherDIMENSION HEALTH
FL1130811OtherCAREPLUS
FL5064999OtherAETNA
FLP01596393OtherRR MEDICARE
FLP969344OtherOPTIMUM