Individual
BERNARD SHUCAVAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12511 WORLD PLAZA LN BLDG 50, FORT MYERS, FL 33907-3991
(239) 939-2622
(239) 939-0151
Mailing address
15391 KILBIRNIE DR, FORT MYERS, FL 33912-2422
(239) 939-2622
(239) 939-0151
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME0046278
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02927
BC/BS FL
FL
05
—
045538500
—
FL
01
—
050009345
RAILROAD MEDICARE
—
01
—
221478
AMERIGROUP
—
Enumeration date
01/20/2006
Last updated
02/28/2013
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