=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356720072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANAMIKA TANDON M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2015
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16106 MARSH RD STE 102
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-9182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-635-3090
-----------------------------------------------------
Fax | 407-636-7816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1026 A AVE NE
-----------------------------------------------------
City | CEDAR RAPIDS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52402-5074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-368-5970
-----------------------------------------------------
Fax | 316-368-5973
-----------------------------------------------------
=====================================================
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 | E-14308
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | MD-44705
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME170925
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------