MEDICARE: DR. SUSAN D FLAGEL 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	208000000X	Pediatrics Physician	3757	IA
2	208000000X	Pediatrics Physician	381	NE
3	208000000X	Pediatrics Physician	OS 10992	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IK203Y	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	32137	OTHER	IA	WELLMARK BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	27579	OTHER	IA	WELLMARK BLUE SHIELD
7	149Q6	OTHER	FL	BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912011222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN D FLAGEL D.O.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	2572 COMMERCE PKWY
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-9356
Country	:	US
Telephone Number	:	941-429-3545
Fax Number	:	941-429-3546

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/25/2020

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Directions to “ DR. SUSAN D FLAGEL D.O.” Practice Location

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