Provider Demographics
NPI:1679503353
Name:YADVEN, MITCHELL W (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:W
Last Name:YADVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
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 1:200 3RD AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-792-0340
Practice Address - Fax:941-794-2251
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0073485208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01040604OtherRAILROAD MCR
FLP933155OtherOPTIMUM
FL353796OtherAVMED
FLP01805322OtherCLEAR HEALTH
FLP102258OtherFREEDOM HEALTH
FL09135OtherUNIVERSAL HEALTHCARE
FL1193524OtherWELLCARE
FL012776300Medicaid
FL41687OtherBCBS FL
FL5836692OtherAETNA
FL5836692OtherAETNA
FL012776300Medicaid