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General NPI Number Information
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NPI Number | 1427247451
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Entity Type | Organization
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Legal Business Name | NABIL S. ITANI DO PA
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 875 CENTURY MEDICAL DR
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City | TITUSVILLE
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State | FL
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Zip | 32796-2142
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Country | US
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Telephone | 321-268-8787
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Fax | 321-383-2424
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Provider Business Mailing Address
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Address Line | 875 CENTURY MEDICAL DR
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City | TITUSVILLE
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State | FL
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Zip | 32796-2142
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Country | US
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Telephone |
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Fax | 321-383-2424
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Authorized Official
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Title or Position | PHYSICIAN
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Name | NABIL SAMIR ITANI
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Credential | D.O.
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Telephone | 321-268-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS9008
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License Number State | FL
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