Provider Demographics
NPI:1083876296
Name:RAMIREZ, MICHELLE LEA (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
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 1:24 W COLE RD STE 104
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9404
Practice Address - Country:US
Practice Address - Phone:160-228-3207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012335208600000X
RICDO00756208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIAA346457OtherHARVARD PILGRIM
RIP01280385OtherRAILROAD MCR
RI4977681OtherAETNA
RI1083876296OtherNEIGHBORHOOD HEALTH PLAN
RI9586301OtherCIGNA
RIMR96210Medicaid
RI4977681OtherAETNA