Healthcare Provider Details

I. General information

NPI: 1649455601
Provider Name (Legal Business Name): AZIM AKBARALI LALANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 59TH ST W STE C
BRADENTON FL
34209-7021
US

IV. Provider business mailing address

2902 59TH ST W STE C
BRADENTON FL
34209-7021
US

V. Phone/Fax

Practice location:
  • Phone: 941-877-7000
  • Fax: 941-242-1440
Mailing address:
  • Phone: 941-877-7000
  • Fax: 941-242-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301085736
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301085736
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 103943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: