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General NPI Number Information
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NPI Number | 1831436005
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Entity Type | Organization
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Legal Business Name | MAHESH BHAMBORE MD PA
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 21762 STATE ROAD 54
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City | LUTZ
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State | FL
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Zip | 33549-6921
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Country | US
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Telephone | 727-403-4573
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Fax |
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Provider Business Mailing Address
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Address Line | 20016 RYMAN PL
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City | TAMPA
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State | FL
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Zip | 33647-3452
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHESH BHAMBORE
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Credential | M.D
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Telephone | 727-403-4573
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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 | ME100193
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License Number State | FL
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