MEDICARE: KANTILAL N. BHADJA M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME48738	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	083738	OTHER	FL	AVMED PROVIDER ID
2	04608	OTHER	FL	BLUE SHIELD ID
3	0622095	OTHER	FL	AETNA PROVIDER#
4	207373	OTHER	FL	WELLCARE PROVIDER ID
5	061105100	OTHER	FL	MEDIPASS ID#
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	401123811	OTHER	FL	CIGNA PROVIDER ID
8	ME487378	OTHER	FL	FLORIDA MEDCIAL LICENSE #
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033162052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANTILAL N. BHADJA M. D.

Provider Business Mailing Address
First Line	:	3010 W AZEELE ST STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3577
Country	:	US
Telephone Number	:	813-251-0194
Fax Number	:	813-254-0279

Provider Business Practice Location Address
First Line	:	3010 W AZEELE ST STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3577
Country	:	US
Telephone Number	:	813-251-0194
Fax Number	:	813-254-0279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/12/2021

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