Provider Demographics
NPI:1457670572
Name:MEDICAL INNOVATIONS INC
Entity Type:Organization
Organization Name:MEDICAL INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAGMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-218-7337
Mailing Address - Street 1:6158 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4432
Mailing Address - Country:US
Mailing Address - Phone:239-218-7337
Mailing Address - Fax:239-432-9546
Practice Address - Street 1:6158 LAKE FRONT DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4432
Practice Address - Country:US
Practice Address - Phone:239-218-7337
Practice Address - Fax:239-432-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty