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NPI Code Detail

MEDICARE: BITA ANSARI DPM

MEDICARE: BITA ANSARI DPM
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
1213E00000XPodiatristPO3210FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
165921OTHERFLBCBS

General Provider Information

NPI Number : 1962451450
Entity Type Code : Individual
Provider Name (Legal Business Name) : BITA ANSARI DPM
Provider Business Mailing Address
First Line : 121 HICKORY CREEK DR
Second Line :
City : BRANDON
State : FL
Zip : 33511-8059
Country : US
Telephone Number : 813-541-8734
Fax Number :
Provider Business Practice Location Address
First Line : 6822 W WATERS AVE
Second Line :
City : TAMPA
State : FL
Zip : 33634-2212
Country : US
Telephone Number : 813-541-8734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 02/28/2018

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Directions to “ BITA ANSARI DPM” Practice Location

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