Provider Demographics
NPI:1942295373
Name:WING, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:WING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3650 EMERGENCY LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5534
Practice Address - Country:US
Practice Address - Phone:863-382-8811
Practice Address - Fax:863-382-6055
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00665312085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258167100Medicaid
FL28857OtherBCBS PROVIDER NUMBER
FL42196OtherFOUNDATION HLTH PROV. #
FL1027139OtherWELLCARE
FL2616613OtherAETNA HMO PROVIDER #
FL2660708OtherCIGNA
FL2734OtherTOTAL HLTH CH. PROV. #
FL279846OtherAVMED PROVIDER #
FL170074OtherWELLCARE PROVIDER NUMBER
FL2660708-008OtherCIGNA PROVIDER NUMBER
FL4934OtherAVMED PIN NUMBER
FL5072119OtherAETNA
FL920005358OtherRAILROAD MCR
FL4099797OtherGHI PROVIDER NUMBER
FL5072119OtherAETNA NON HMO PROVIDER #
FL42196OtherFOUNDATION HLTH PROV. #
FL4934OtherAVMED PIN NUMBER