Basic Information
| Provider Information | |||||||||
| NPI: | 1912993536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTOSEK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | MANAGED CARE DEPT | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 8890 W OAKLAND PARK BLVD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333517235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547484771 | ||||||||
| FaxNumber: | 9547486755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | OS5171 | FL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | P01731861 | 01 | FL | SIMPLY HEALTHCARE | OTHER | 1192925 | 01 | FL | WELLCARE | OTHER | 400021284002 | 01 | FL | PREFERRED CARE PARTNERS | OTHER | 372820000 | 05 | FL | MEDICAID | 400021284000 | 01 | FL | PREFERRED CARE PARTNERS | OTHER | P01609954 | 01 | FL | RR MEDICARE | OTHER | 36450 | 01 | FL | UNIVERSAL HEALTHCARE | OTHER | P00474376 | 01 | FL | RAILROAD MEDICARE | OTHER | QMP000003894957 | 01 | FL | MOLINA | OTHER | 400021284003 | 01 | FL | PREFERRED CARE PARTNERS | OTHER | 5241320 | 01 | FL | AETNA PROVIDER # | OTHER | 400021284001 | 01 | FL | PREFERRED CARE PARTNERS | OTHER | P0003180 | 01 | FL | FLORIDA HEALTHCARE PLUS | OTHER | 82947 | 01 | FL | BCBS FL | OTHER | 9801 | 01 | FL | MEDICA HEALTH PLANS | OTHER |