MEDICARE: ASHOK MITTAL MD

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	207RP1001X	Pulmonary Disease Physician	ME72885	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164496055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHOK MITTAL MD

Provider Business Mailing Address
First Line	:	6185 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1807
Country	:	US
Telephone Number	:	727-545-1199
Fax Number	:	727-545-9988

Provider Business Practice Location Address
First Line	:	6185 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1807
Country	:	US
Telephone Number	:	727-545-1199
Fax Number	:	727-545-9988

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/06/2010

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