MEDICARE: ALBERT VORSTMAN M.D.

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	174400000X	Specialist	ME0043001	FL
2	208800000X	Urology Physician	ME43001	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01604628	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	96884	OTHER	FL	BCBS
3	2511922	OTHER	FL	CIGNA
4	P02353	OTHER	FL	FREEDOM
5	P971166	OTHER	FL	OPTIMUM
6	212044	OTHER	FL	AVMED
7	4068171	OTHER	FL	AETNA
8	2706	OTHER	FL	DIMENSION HEALTH

General Provider Information

NPI Number	:	1477581155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT VORSTMAN M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	1725 N UNIVERSITY DR
Second Line	:	SUITE 400
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6089
Country	:	US
Telephone Number	:	954-752-3166
Fax Number	:	954-753-5628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/07/2016

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