Provider Demographics
NPI:1609179498
Name:AZIZ JUNAGADHWALLA MD PA
Entity Type:Organization
Organization Name:AZIZ JUNAGADHWALLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNAGADHWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-484-0651
Mailing Address - Street 1:732 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3524
Mailing Address - Country:US
Mailing Address - Phone:941-484-0651
Mailing Address - Fax:941-484-0652
Practice Address - Street 1:732 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3524
Practice Address - Country:US
Practice Address - Phone:941-484-0651
Practice Address - Fax:941-484-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME034635261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801969050OtherINDIVIDUAL NPI
FL371283400Medicaid