Provider Demographics
NPI:1770631475
Name:NAWALANY, MICHAL (MD)
Entity type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:NAWALANY
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9960
Mailing Address - Fax:239-343-9977
Practice Address - Street 1:12700 CREEKSIDE LN STE 301
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:239-343-3780
Practice Address - Fax:239-343-3781
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI512142086S0129X, 2086S0129X
FLME1546912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113683500Medicaid