Provider Demographics
NPI:1619961091
Name:MICHEL, ERNST BERTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ERNST
Middle Name:BERTHONY
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BERTHONY
Other - Middle Name:
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:5851 TIMUQUANA RD STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7899
Practice Address - Country:US
Practice Address - Phone:904-674-2699
Practice Address - Fax:904-674-6710
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00346091OtherRAILROAD MEDICARE
FL2760061-00Medicaid
GA667530690AMedicaid
FLP00346091OtherRAILROAD MEDICARE
FL2760061-00Medicaid