Provider Demographics
NPI:1982760369
Name:BALANDRA, ARTURO (MD)
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:
Last Name:BALANDRA
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: 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:
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:SUITE 250
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-434-8565
Practice Address - Fax:239-434-8569
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188365208800000X
FLME109228208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3298242OtherUNITED HEALTHCARE
FLP00956370OtherRAILROAD MEDICARE
FLP959228OtherOPTIMUM
FLP996671OtherFREEDOM
FL6677242OtherCIGNA
FL003495400Medicaid
FL14CV6OtherBCBS OF FL
FL9036668OtherAETNA
FL3298242OtherUNITED HEALTHCARE