Provider Demographics
NPI:1033759527
Name:INTERNAL MEDICINE OF TAMPA BAY
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF TAMPA BAY
Other - Org Name:INTERNAL MEDICINE OF TAMPA BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-269-5618
Mailing Address - Street 1:PO BOX 49106
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-9106
Mailing Address - Country:US
Mailing Address - Phone:727-269-5618
Mailing Address - Fax:727-265-3420
Practice Address - Street 1:2835 W DE LEON ST STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:813-336-5808
Practice Address - Fax:813-822-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004191800Medicaid