Individual
DR. DAMIAN CHARLES HANEKOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2441 SURFSIDE BLVD STE 200, CAPE CORAL, FL 33914-3861
(239) 424-1499
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 541-7500
(239) 541-7501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.068045
IL
207Q00000X
Family Medicine Physician
Primary
ME139796
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103450000
—
FL
Enumeration date
05/03/2016
Last updated
06/14/2024
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