MEDICARE: DR. DIEGO P ANDRADE 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	207L00000X	Anesthesiology Physician	ME0087283	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0867335	OTHER	FL	CIGNA
2	29149Z	OTHER	FL	MCR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P00032667	OTHER	FL	MCRR
5	3127321	OTHER	FL	AETNA
6	29149	OTHER	FL	BSFL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023011749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEGO P ANDRADE M.D.

Provider Business Mailing Address
First Line	:	4048 EVANS AVE
Second Line	:	STE 303
City	:	FT MYERS
State	:	FL
Zip	:	33901-9390
Country	:	US
Telephone Number	:	239-332-5344
Fax Number	:	239-332-7246

Provider Business Practice Location Address
First Line	:	4048 EVANS AVE
Second Line	:	STE 303
City	:	FT MYERS
State	:	FL
Zip	:	33901-9390
Country	:	US
Telephone Number	:	239-332-5344
Fax Number	:	239-332-7246

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/20/2008

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Directions to “ DR. DIEGO P ANDRADE M.D.” Practice Location

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