Provider Demographics
NPI:1992775589
Name:HAVIG, MICHAEL TERRANCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TERRANCE
Last Name:HAVIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 PINE RIDGE RD BLDG 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:239-449-3072
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:1250 PINE RIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8913
Practice Address - Country:US
Practice Address - Phone:239-325-1135
Practice Address - Fax:239-262-3843
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076299207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43995OtherBLUE CROSS
FL255278700Medicaid
FL43995XMedicare PIN
FL43995OtherBLUE CROSS