MEDICARE: DR. BANSIDAS M AGRAVAT 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	207P00000X	Emergency Medicine Physician	ME25973	FL

General Provider Information

NPI Number	:	1124092044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BANSIDAS M AGRAVAT M.D

Provider Business Mailing Address
First Line	:	1300 MICCOSUKEE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5054
Country	:	US
Telephone Number	:	850-431-0756
Fax Number	:	850-431-0779

Provider Business Practice Location Address
First Line	:	1300 MICCOSUKEE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5054
Country	:	US
Telephone Number	:	850-431-0756
Fax Number	:	850-431-0779

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/06/2023

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