MEDICARE: ADVANCED PAIN MANAGEMENT SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CH8338	OTHER	FL	RAILROAD MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7926233	OTHER	FL	AETNA GROUP NUMBER
2	74588	OTHER	FL	BCBS/FL GROUP NUMBER

General Provider Information

NPI Number	:	1437248150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN MANAGEMENT SPECIALISTS

Provider Business Mailing Address
First Line	:	PO BOX 07400
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-0400
Country	:	US
Telephone Number	:	239-437-8000
Fax Number	:	239-437-9991

Provider Business Practice Location Address
First Line	:	1425 VISCAYA PKWY
Second Line	:	SUITE 202
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3294
Country	:	US
Telephone Number	:	239-574-1464
Fax Number	:	239-574-1286

Authorized Official
Title or Position	:	PARTNER
Name	:	JONATHAN S. DAITCH
Credential	:	MD
Telephone Number	:	239-437-8002

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

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Directions to “ADVANCED PAIN MANAGEMENT SPECIALISTS ” Practice Location

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