Healthcare Provider Details

I. General information

NPI: 1154330165
Provider Name (Legal Business Name): ANANTH K PILLAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E MAIN ST
BARTOW FL
33830-5006
US

IV. Provider business mailing address

1265 E MAIN ST
BARTOW FL
33830-5006
US

V. Phone/Fax

Practice location:
  • Phone: 863-534-3737
  • Fax: 863-533-6323
Mailing address:
  • Phone: 863-534-3737
  • Fax: 863-533-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: