Healthcare Provider Details

I. General information

NPI: 1811916950
Provider Name (Legal Business Name): ANDREW K. WEITZEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 HARBOR BLVD UNIT D
PT CHARLOTTE FL
33952-6754
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-1550
  • Fax: 941-255-0794
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberOS9827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: