Basic Information
Provider Information
NPI: 1003294604
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BISHOP
FirstName: MICAH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DVM, DACVIM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10130 MARKET ST
Address2: SUITE 1
City: NAPLES
State: FL
PostalCode: 341123444
CountryCode: US
TelephoneNumber: 2392630480
FaxNumber: 2392630488
Practice Location
Address1: 10130 MARKET ST
Address2: SUITE 1
City: NAPLES
State: FL
PostalCode: 341123444
CountryCode: US
TelephoneNumber: 2392630480
FaxNumber: 2392630488
Other Information
ProviderEnumerationDate: 05/14/2015
LastUpdateDate: 05/14/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174M00000X10569TXN Other Service ProvidersVeterinarian 
174M00000XVM12748FLY Other Service ProvidersVeterinarian 

No ID Information.


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