Provider Demographics
NPI:1417167784
Name:SHUSTER, ADAM MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7531
Mailing Address - Country:US
Mailing Address - Phone:239-333-1177
Mailing Address - Fax:239-333-1169
Practice Address - Street 1:7964 SUMMERLIN LAKES DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1816
Practice Address - Country:US
Practice Address - Phone:239-333-1177
Practice Address - Fax:239-333-1169
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015925207L00000X
FLOS10812207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146VAOtherBLUE CROSS BLUE SHIELD
FL146VAOtherBLUE CROSS BLUE SHIELD