Healthcare Provider Details

I. General information

NPI: 1184635385
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF VENICE & ENGLEWOOD P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8421 POINTE LOOP DR
VENICE FL
34293-2232
US

IV. Provider business mailing address

PO BOX 1764
VENICE FL
34284-1764
US

V. Phone/Fax

Practice location:
  • Phone: 941-412-9787
  • Fax: 941-480-0388
Mailing address:
  • Phone: 941-412-9787
  • Fax: 941-480-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME57290
License Number StateFL

VIII. Authorized Official

Name: DR. TARIQ J KHAN
Title or Position: MD PRESIDENT
Credential: MD
Phone: 941-412-9787