Individual
LAERTES A MANUELIDIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8381 RIVERWALK PARK BLVD, SUITE 1, FORT MYERS, FL 33919-8760
(239) 936-5425
(239) 936-5176
Mailing address
8381 RIVERWALK PARK BLVD, SUITE 101, FORT MYERS, FL 33919-8760
(239) 936-5425
(239) 936-5176
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
ME87314
FL
207ZD0900X
Dermatopathology (Pathology) Physician
ME87314
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7082420
AETNA
FL
01
—
78611
BC BS OF FLA
FL
01
—
P00038301
RR MEDICARE
FL
Enumeration date
10/26/2005
Last updated
09/11/2025
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