MEDICARE: NITIN BAWA, PA

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	207R00000X	Internal Medicine Physician	ME91017	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	:	1588846257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NITIN BAWA, PA

Provider Business Mailing Address
First Line	:	4476 LEGENDARY DR STE 100
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-5347
Country	:	US
Telephone Number	:	850-424-7320
Fax Number	:	850-424-7322

Provider Business Practice Location Address
First Line	:	4476 LEGENDARY DR STE 100
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-5347
Country	:	US
Telephone Number	:	850-424-7320
Fax Number	:	850-424-7322

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. NITIN BAWA
Credential	:	M.D.
Telephone Number	:	850-534-4170

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	06/02/2026

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Directions to “NITIN BAWA, PA ” Practice Location

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