=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700089828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGESTIVE DISEASE SPECIALISTS P L
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2007
-----------------------------------------------------
Last Update Date | 11/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8340 LAKEWOOD RANCH BLVD SUITE 101
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34202-5180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-361-1100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8374 MARKET ST #475
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34202-5137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-361-1100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARUN PUNWANI KHAZANCHI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 941-388-6976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME86268
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------