MEDICARE: ANDREW K. WEITZEL D.O.

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	208800000X	Urology Physician	OS9827	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS9827	OTHER	FL	METCARE PROVIDER #
2	258608	OTHER	FL	AVMED
3	54327	OTHER	FL	BCBS FL PROVIDER #
4	1193518	OTHER	FL	WELLCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	QMP000005122907	OTHER	FL	MOLINA
7	5127	OTHER	FL	OPER. ENGIN. PROV. #
8	5839421	OTHER	FL	AETNA PROVIDER #
9	P01791741	OTHER	FL	CLEAR HEALTH ALLIANCE
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811916950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW K. WEITZEL D.O.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:
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	:	3161 HARBOR BLVD
Second Line	:	UNIT D
City	:	PT CHARLOTTE
State	:	FL
Zip	:	33952-6754
Country	:	US
Telephone Number	:	941-625-1550
Fax Number	:	941-255-0794

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/21/2017

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