Individual
CHARLES HOMOLKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12511 WORLD PLAZA LN BLDG 50, FORT MYERS, FL 33907-3991
(239) 939-2622
(239) 939-0151
Mailing address
11760 HAMPTON GREENS DR, FORT MYERS, FL 33913-8325
(239) 939-2622
(239) 939-0151
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME70760
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050046654
RAILROAD MEDICARE
—
01
—
222990
AMERIGROUP
—
05
—
252581000
—
FL
01
—
32297
BC/BS FL
FL
Enumeration date
01/20/2006
Last updated
03/01/2024
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