Provider Demographics
NPI:1851662183
Name:ESTERO ISLAND MEDICAL CARE LLC
Entity Type:Organization
Organization Name:ESTERO ISLAND MEDICAL CARE LLC
Other - Org Name:ESTERO ISLAND MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-463-5741
Mailing Address - Street 1:6875 ESTERO BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-4608
Mailing Address - Country:US
Mailing Address - Phone:239-463-5741
Mailing Address - Fax:239-463-5578
Practice Address - Street 1:6875 ESTERO BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS BEACH
Practice Address - State:FL
Practice Address - Zip Code:33931-4608
Practice Address - Country:US
Practice Address - Phone:239-463-5741
Practice Address - Fax:239-463-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49188173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty