MEDICARE: MR. IMRAN Q SAMNANI M.D.

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	207P00000X	Emergency Medicine Physician	ME98459	FL
2	207RI0200X	Infectious Disease Physician	ME98459	FL
3	208M00000X	Hospitalist Physician	ME98459	FL
4	207R00000X	Internal Medicine Physician	ME98459	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	:	1801829098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IMRAN Q SAMNANI M.D.

Provider Business Mailing Address
First Line	:	12470 TELECOM DR STE 100
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0904
Country	:	US
Telephone Number	:	813-779-6303
Fax Number	:	888-977-1998

Provider Business Practice Location Address
First Line	:	LAKE CITY VA
Second Line	:	619 S. MARION AVE
City	:	LAKECITY
State	:	FL
Zip	:	32025-3202
Country	:	US
Telephone Number	:	386-755-3016
Fax Number	:

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	12/14/2018

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Directions to “ MR. IMRAN Q SAMNANI M.D.” Practice Location

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