Organization
ANNETTE M ST PIERRE MACKOUL MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISET FLEITAS (OFFICE MANAGER)
(239) 415-1131
Entity
Organization
Contact information
Practice address
8530 GRANITE CT, FORT MYERS, FL 33908-4102
(239) 415-1131
(239) 415-1136
Mailing address
8530 GRANITE CT, FORT MYERS, FL 33908-4102
(239) 415-1131
(239) 415-1136
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME67399
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000697700
—
FL
05
—
003463600
—
FL
05
—
024174700
—
FL
05
—
377085100
—
FL
Enumeration date
03/02/2011
Last updated
05/28/2020
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