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NPI Code Detail

MEDICARE: NABIL S ITANI DO

MEDICARE: NABIL S ITANI DO
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
1207R00000XInternal Medicine PhysicianOS9008FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00083909OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13460876OTHERFLAETNA HMO
27391566OTHERFLAETNA
382059OTHERFLBC/BS

General Provider Information

NPI Number : 1912009168
Entity Type Code : Individual
Provider Name (Legal Business Name) : NABIL S ITANI DO
Provider Business Mailing Address
First Line : 875 CENTURY MEDICAL DR
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-2142
Country : US
Telephone Number : 321-268-8787
Fax Number : 321-383-2424
Provider Business Practice Location Address
First Line : 875 CENTURY MEDICAL DR
Second Line :
City : TITUSVILLE
State : FL
Zip : 32796-2142
Country : US
Telephone Number : 321-268-8787
Fax Number : 321-383-2424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2006
Last Update Date : 10/15/2007

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Directions to “ NABIL S ITANI DO” Practice Location

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