Healthcare Provider Details

I. General information

NPI: 1740211952
Provider Name (Legal Business Name): MAGAN BAKARANIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 OAKFIELD DR SUITE A
BRANDON FL
33511-5723
US

IV. Provider business mailing address

321 E ROBERTSON ST
BRANDON FL
33511-5253
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-1912
  • Fax: 813-684-3335
Mailing address:
  • Phone: 813-685-2191
  • Fax: 813-689-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0036154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: