Provider Demographics
NPI:1811916950
Name:WEITZEL, ANDREW K (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:WEITZEL
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 1:2234 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 1:3161 HARBOR BLVD
Practice Address - Street 2:UNIT D
Practice Address - City:PT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6754
Practice Address - Country:US
Practice Address - Phone:941-625-1550
Practice Address - Fax:941-255-0794
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9827208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS9827OtherMETCARE PROVIDER #
FL258608OtherAVMED
FL54327OtherBCBS FL PROVIDER #
FL1193518OtherWELLCARE
FL279029700Medicaid
FLQMP000005122907OtherMOLINA
FL5127OtherOPER. ENGIN. PROV. #
FL5839421OtherAETNA PROVIDER #
FLP01791741OtherCLEAR HEALTH ALLIANCE
FL54327OtherBCBS FL PROVIDER #
FL258608OtherAVMED