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General NPI Number Information
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NPI Number | 1205217619
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Entity Type | Individual
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Provider Name | ANDREW PAUL VAN SICKLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 12700 CREEKSIDE LN STE 301
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City | FORT MYERS
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State | FL
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Zip | 33919-3356
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Country | US
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Telephone | 239-343-3780
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Fax | 239-343-3781
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-3780
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Fax | 239-343-3781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME155673
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License Number State | FL
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