Provider Demographics
NPI:1619216314
Name:PAIN MANAGEMENT CONSULTANTS OF SOUTHWEST FLORIDA, PL
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CONSULTANTS OF SOUTHWEST FLORIDA, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VELIMIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MICOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-333-1177
Mailing Address - Street 1:23 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7531
Mailing Address - Country:US
Mailing Address - Phone:605-988-4883
Mailing Address - Fax:
Practice Address - Street 1:7964 SUMMERLIN LAKES DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1816
Practice Address - Country:US
Practice Address - Phone:239-333-1777
Practice Address - Fax:239-333-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain