Healthcare Provider Details

I. General information

NPI: 1982158143
Provider Name (Legal Business Name): ASADULLAH JAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 HARDEN BLVD
LAKELAND FL
33803-7952
US

IV. Provider business mailing address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-3950
  • Fax:
Mailing address:
  • Phone: 206-471-5817
  • Fax: 667-234-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME178176
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP33504
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: