Provider Demographics
NPI:1245274927
Name:HAUPT, MICHAEL C (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:HAUPT
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:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-278-3203
Practice Address - Street 1:708 DEL PRADO BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-574-2644
Practice Address - Fax:239-574-1451
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49906207P00000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL231025OtherAMERIGROUP
FL04476XOtherMEDICARE PTAN
FL046057500Medicaid
FL2567719OtherCIGNA
FL930074798OtherRAILROAD
FL4235619OtherAETNA
FL04467OtherBLUE CROSS BLUE SHIELD
FL231025OtherAMERIGROUP
FL04476XOtherMEDICARE PTAN
FL04467VMedicare ID - Type Unspecified
FL046057500Medicaid