Provider Demographics
NPI:1073659199
Name:MICHAEL T HAVIG MD PL
Entity Type:Organization
Organization Name:MICHAEL T HAVIG MD PL
Other - Org Name:MICHAEL T HAVIG MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-325-1135
Mailing Address - Street 1:1350 TAMIAMI TRL N
Mailing Address - Street 2:#202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5203
Mailing Address - Country:US
Mailing Address - Phone:239-325-1135
Mailing Address - Fax:239-262-3843
Practice Address - Street 1:1350 TAMIAMI TRL N
Practice Address - Street 2:#202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5203
Practice Address - Country:US
Practice Address - Phone:239-325-1135
Practice Address - Fax:239-262-3843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076299207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1410Medicare PIN