Healthcare Provider Details

I. General information

NPI: 1982760369
Provider Name (Legal Business Name): ARTURO BALANDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 S TAMIAMI TRL SUITE 250
BONITA SPRINGS FL
34134-4349
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: MANAGED CARE DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-8565
  • Fax: 239-434-8569
Mailing address:
  • Phone: 239-931-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMT188365
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME109228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: