Provider Demographics
NPI:1356387369
Name:FORSZPANIAK, JAN (MD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:FORSZPANIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
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 1:730 GOODLETTE RD N
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5616
Practice Address - Country:US
Practice Address - Phone:239-263-4499
Practice Address - Fax:239-263-8992
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046907208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271771OtherAVMED
FLP00375806OtherRAILROAD MEDICARE
FL12076OtherUNIVERSAL PROV. #
FL703397OtherWELLCARE
FL17913OtherOPERATING ENG. PROVIDER #
FL372219800Medicaid
FL12076OtherUNIVERSAL PROV. #
FL04364ZMedicare PIN
D20913Medicare UPIN