Healthcare Provider Details

I. General information

NPI: 1669408910
Provider Name (Legal Business Name): AMITABH GOEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8936 77TH TER E UNIT 101
LAKEWOOD RANCH FL
34202-6419
US

IV. Provider business mailing address

8936 77TH TER E UNIT 101
LAKEWOOD RANCH FL
34202-6419
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-2500
  • Fax:
Mailing address:
  • Phone: 941-923-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number24943
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME77381
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: