Provider Demographics
NPI:1669639183
Name:BAY AREA NEUROLOGY CONSULTANTS PL
Entity Type:Organization
Organization Name:BAY AREA NEUROLOGY CONSULTANTS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLAUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-567-7364
Mailing Address - Street 1:13417 US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5446
Mailing Address - Country:US
Mailing Address - Phone:352-567-7364
Mailing Address - Fax:352-567-7394
Practice Address - Street 1:13417 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5446
Practice Address - Country:US
Practice Address - Phone:352-567-7364
Practice Address - Fax:352-567-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME903472084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6218Medicare PIN