Healthcare Provider Details

I. General information

NPI: 1053706044
Provider Name (Legal Business Name): ALEEM BAKHTIAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANDON REGIONAL HOSPITAL 119 OAKFIELD DRIVE
BRANDON FL
33511
US

IV. Provider business mailing address

1204 E CUMBERLAND AVE UNIT 304
TAMPA FL
33602-4228
US

V. Phone/Fax

Practice location:
  • Phone: 414-241-0616
  • Fax:
Mailing address:
  • Phone: 414-241-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number141569
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number74048
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: