Healthcare Provider Details

I. General information

NPI: 1902853013
Provider Name (Legal Business Name): APURBA MANIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEARTLAND WAY
WAUCHULA FL
33873-5000
US

IV. Provider business mailing address

120 HEARTLAND WAY
WAUCHULA FL
33873-5000
US

V. Phone/Fax

Practice location:
  • Phone: 863-767-1414
  • Fax: 863-767-1763
Mailing address:
  • Phone: 863-767-1414
  • Fax: 863-767-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME72938
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: