Individual
MITCHELL LEE PETUSEVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 2ND AVE N, SUITE 305, NAPLES, FL 34102-5756
(239) 263-8385
(239) 263-8592
Mailing address
3434 HANCOCK BRIDGE PKWY, SUITE 301, NORTH FORT MYERS, FL 33903-7094
(877) 856-3774
(239) 599-2625
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
FLME0042752
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064860400
—
FL
Enumeration date
05/13/2006
Last updated
03/03/2014
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