Provider Demographics
NPI:1093793440
Name:WEINSTEIN, MITCHELL D (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:D
Last Name:WEINSTEIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7235
Practice Address - Country:US
Practice Address - Phone:954-748-4771
Practice Address - Fax:954-748-6755
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6130204D00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL400021279003OtherPREFERRED CARE PARTNERS
FL400021279001OtherPREFERRED CARE PARTNERS
FL372819600Medicaid
FLP0003176OtherFLORIDA HEALTHCARE PLUS
FL400021279002OtherPREFERRED CARE PARTNERS
FL5101549OtherAETNA PROVIDER #
FL80515OtherBCBS FL
FL77215OtherGROUP PTAN
FLP00474384OtherRR MEDICARE
FL1193514OtherWELLCARE
FL26534OtherUNIVERSAL HEALTHCARE
FL400021279000OtherPREFERRED CARE PARTNERS
FLP01709698OtherSIMPLY HEALTHCARE
FL80515VMedicare PIN
FL26534OtherUNIVERSAL HEALTHCARE