Individual
DAVID A MACKOUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 SE 16TH PL, CAPE CORAL, FL 33990
(239) 573-2001
(239) 573-2006
Mailing address
206 SE 16TH PL, CAPE CORAL, FL 33990
(239) 573-2001
(239) 573-2006
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
ME67400
FL
208000000X
Pediatrics Physician
Primary
ME67400
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258711400
—
FL
05
—
258711402
—
FL
05
—
377086900
—
FL
Enumeration date
10/19/2005
Last updated
11/08/2010
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