Provider Demographics
NPI:1831414143
Name:GORBATIY, VLADISLAV (MD)
Entity type:Individual
Prefix:DR
First Name:VLADISLAV
Middle Name:
Last Name:GORBATIY
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: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 1:1200 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2134
Practice Address - Country:US
Practice Address - Phone:954-463-6408
Practice Address - Fax:954-463-1858
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN#14540390200000X
FLME110963208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP0005386OtherFLORIDA HEALTHCARE PLUS
FLP943414OtherOPTIMUM
FL25877OtherMEDICA
FL13088OtherDIMENSIONS HEALTH
FL14LY8OtherBCBS FL
FL3674924OtherCIGNA
FL006449600Medicaid
FL813583OtherWELLCARE
FLP01727492OtherSIMPLY HEALTHCARE
FL9916895OtherAETNA
FLP01099396OtherRAILROAD MEDICARE
FLQMP000004921476OtherMOLINA
FLF00349514201OtherUNITED HEALTHCARE
FLP1002957OtherFREEDOM HEALTH
FLP01099396OtherRAILROAD MEDICARE