Individual
DR. MICHAEL ROBERT BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
12670 CREEKSIDE LN STE 202, FORT MYERS, FL 33919-3370
(239) 482-2663
(239) 482-7585
Mailing address
12670 CREEKSIDE LN STE 202, FORT MYERS, FL 33919-3370
(239) 482-2663
(239) 482-7585
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
PL00000830
WA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3431
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DJ551Y
MEDICARE PTAN
FL
Enumeration date
10/12/2007
Last updated
05/06/2025
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