Provider Demographics
NPI:1417233818
Name:AJ BIDANI, M.D. PA
Entity Type:Organization
Organization Name:AJ BIDANI, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-393-1155
Mailing Address - Street 1:8787 BRYAN DAIRY RD
Mailing Address - Street 2:STE 310
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1251
Mailing Address - Country:US
Mailing Address - Phone:727-393-1155
Mailing Address - Fax:
Practice Address - Street 1:8787 BRYAN DAIRY RD
Practice Address - Street 2:STE 310
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1251
Practice Address - Country:US
Practice Address - Phone:727-393-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068608207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty