Provider Demographics
NPI:1659365435
Name:NOVOTNEY, MICHAEL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:NOVOTNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8010 SUMMERLIN LAKES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1849
Mailing Address - Country:US
Mailing Address - Phone:239-939-1767
Mailing Address - Fax:239-939-5895
Practice Address - Street 1:8010 SUMMERLIN LAKES DR STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1849
Practice Address - Country:US
Practice Address - Phone:239-939-1767
Practice Address - Fax:239-939-5895
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME803042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58862OtherBCBS
FL201842448OtherTAX ID
FL58862OtherBCBS