Provider Demographics
NPI:1750479952
Name:AGABANI, MOTAZ (MD)
Entity Type:Individual
Prefix:
First Name:MOTAZ
Middle Name:
Last Name:AGABANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 BAHIA VISTA
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2611
Mailing Address - Country:US
Mailing Address - Phone:941-330-8355
Mailing Address - Fax:941-330-1445
Practice Address - Street 1:2650 BAHIA VISTA
Practice Address - Street 2:SUITE 104
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2611
Practice Address - Country:US
Practice Address - Phone:941-330-8355
Practice Address - Fax:941-330-1445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75756207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17928Medicare UPIN
43752Medicare ID - Type Unspecified