MEDICARE: VITA ANKSH M D P A

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	ME83804	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205920444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITA ANKSH M D P A

Provider Business Mailing Address
First Line	:	PO BOX 110465
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34108-0108
Country	:	US
Telephone Number	:	239-254-1316
Fax Number	:

Provider Business Practice Location Address
First Line	:	9010 STRADA STELL CT
Second Line	:	SUITE 203
City	:	NAPLES
State	:	FL
Zip	:	34109-4424
Country	:	US
Telephone Number	:	239-254-1316
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	VITA ANKSH
Credential	:	M.D.
Telephone Number	:	239-254-1316

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/30/2008

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