MEDICARE: FUJII INNOVATIVE THERAPEUTICS

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician
2	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1811502594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUJII INNOVATIVE THERAPEUTICS

Provider Business Mailing Address
First Line	:	PO BOX 320269
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33679-2269
Country	:	US
Telephone Number	:	813-579-2699
Fax Number	:	888-508-1859

Provider Business Practice Location Address
First Line	:	1001 N MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5152
Country	:	US
Telephone Number	:	813-579-2699
Fax Number	:	888-508-1859

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. BOB WHITFIELD
Credential	:
Telephone Number	:	813-579-2699

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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