Provider Demographics
NPI:1184635385
Name:GASTROENTEROLOGY ASSOCIATES OF VENICE & ENGLEWOOD P A
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF VENICE & ENGLEWOOD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:J
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-412-9787
Mailing Address - Street 1:PO BOX 1764
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284-1764
Mailing Address - Country:US
Mailing Address - Phone:941-412-9787
Mailing Address - Fax:941-480-0388
Practice Address - Street 1:8421 POINTE LOOP DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2232
Practice Address - Country:US
Practice Address - Phone:941-412-9787
Practice Address - Fax:941-480-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7370390OtherAETNA
FL34112OtherBLUE CROSS
FLCJ5399OtherRAILROAD MEDICARE
FL34112OtherBLUE CROSS