Individual
ROSHAN K VATTHYAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9800 S HEALTH PARK DRIVE, SUITE 320, FORT MYERS, FL 33908-3630
(239) 343-6350
(239) 343-6358
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-6350
(239) 343-6358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME109924
FL
207RC0000X
Cardiovascular Disease Physician
ME109924
FL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
ME109924
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000614311
ANTHEM BCBS
IN
05
—
003857000
—
FL
05
—
200938050
—
IN
Enumeration date
06/26/2008
Last updated
03/30/2021
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