Provider Demographics
NPI:1912993536
Name:ANTOSEK, RICHARD B (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:ANTOSEK
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:MANAGED CARE DEPT
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 1:8890 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7235
Practice Address - Country:US
Practice Address - Phone:954-748-4771
Practice Address - Fax:954-748-6755
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5171208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01731861OtherSIMPLY HEALTHCARE
FL1192925OtherWELLCARE
FL400021284002OtherPREFERRED CARE PARTNERS
FL372820000Medicaid
FL400021284000OtherPREFERRED CARE PARTNERS
FLP01609954OtherRR MEDICARE
FL36450OtherUNIVERSAL HEALTHCARE
FLP00474376OtherRAILROAD MEDICARE
FLQMP000003894957OtherMOLINA
FL400021284003OtherPREFERRED CARE PARTNERS
FL5241320OtherAETNA PROVIDER #
FL400021284001OtherPREFERRED CARE PARTNERS
FLP0003180OtherFLORIDA HEALTHCARE PLUS
FL82947OtherBCBS FL
FL9801OtherMEDICA HEALTH PLANS
FL400021284003OtherPREFERRED CARE PARTNERS
FL82947OtherBCBS FL
FL5241320OtherAETNA PROVIDER #
FLP01731861OtherSIMPLY HEALTHCARE
FLD27406Medicare UPIN