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General NPI Number Information
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NPI Number | 1346271673
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Entity Type | Organization
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Legal Business Name | IDEAL BODY BETTER HEALTH PA
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/07/2011
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Provider Practice Location Address
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Address Line | 8610 E STATE ROAD 70
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City | BRADENTON
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State | FL
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Zip | 34202-3785
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Country | US
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Telephone | 941-752-2222
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Fax | 941-758-4045
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Provider Business Mailing Address
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Address Line | 360 BLACKBIRD CT
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City | BRADENTON
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State | FL
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Zip | 34212-2943
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Country | US
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Telephone | 941-752-2222
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Fax | 941-758-4045
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASDOLLAH LIVANI
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Credential | M.D
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Telephone | 941-752-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0073595
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License Number State | FL
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