Provider Demographics
NPI:1003294604
Name:BISHOP, MICAH (DVM, DACVIM)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:BISHOP
Suffix:
Gender:M
Credentials:DVM, DACVIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 MARKET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-3444
Mailing Address - Country:US
Mailing Address - Phone:239-263-0480
Mailing Address - Fax:239-263-0488
Practice Address - Street 1:10130 MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-3444
Practice Address - Country:US
Practice Address - Phone:239-263-0480
Practice Address - Fax:239-263-0488
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM12748174M00000X
TX10569174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian