Provider Demographics
NPI:1609889567
Name:PFEILSTICKER, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:PFEILSTICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6302 MANATEE AVE W.
Mailing Address - Street 2:SUITE I-2
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3851
Mailing Address - Country:US
Mailing Address - Phone:941-747-2282
Mailing Address - Fax:941-792-0006
Practice Address - Street 1:6302 MANATEE AVE W
Practice Address - Street 2:SUITE I-2
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2377
Practice Address - Country:US
Practice Address - Phone:941-747-2282
Practice Address - Fax:941-757-0656
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME46226208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266225600Medicaid
FLK5861OtherMEDICARE ID - TYPE UNSPECIFIED
FLD86033Medicare UPIN