MEDICARE: FREDERIC L BUSHKIN 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	208600000X	Surgery Physician	ME21234	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	91698	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4068300	OTHER	FL	AETNA
4	961642	OTHER	FL	WELLCARE
5	P971336	OTHER	FL	OPTIMUM
6	1666861	OTHER	FL	CIGNA
7	208599	OTHER	FL	AVMED
8	8902	OTHER	FL	DIMENSION
9	P1035576	OTHER	FL	FREEDOM
10	QMP0000004939254	OTHER	FL	MOLINA

General Provider Information

NPI Number	:	1942454210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERIC L BUSHKIN M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
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	:	3800 JOHNSON ST
Second Line	:	SECOND FLOOR, SUITE E
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6030
Country	:	US
Telephone Number	:	954-985-9336
Fax Number	:	954-985-9338

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

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	05/03/2017

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Directions to “ FREDERIC L BUSHKIN M.D.” Practice Location

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