Healthcare Provider Details

I. General information

NPI: 1699898700
Provider Name (Legal Business Name): MA, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19260 FISHERMANS BEND DRIVE
LUTZ FL
33558
US

IV. Provider business mailing address

19260 FISHERMANS BEND DRIVE
LUTZ FL
33558
US

V. Phone/Fax

Practice location:
  • Phone: 813-345-3937
  • Fax:
Mailing address:
  • Phone: 813-345-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LI MA
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 813-345-3937