=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013962299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VAKESH RAJANI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 05/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 MEASE DR SUITE 401B
-----------------------------------------------------
City | SAFETY HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-328-4633
-----------------------------------------------------
Fax | 727-726-0529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25636
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33622-5636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-328-4633
-----------------------------------------------------
Fax | 727-726-0529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME 77964
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------