Healthcare Provider Details

I. General information

NPI: 1902859911
Provider Name (Legal Business Name): JAIN PANATTIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-0706
  • Fax: 813-974-4325
Mailing address:
  • Phone: 813-974-0706
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMFC1591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: