Provider Demographics
NPI:1821184615
Name:BAYANI, ANTONIO MANALILI (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MANALILI
Last Name:BAYANI
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:PO BOX 862506
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886
Mailing Address - Country:US
Mailing Address - Phone:913-754-0467
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:2901 W. SWANN AVE.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:913-754-0467
Practice Address - Fax:913-341-5797
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27256207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036042200Medicaid
FL050076795OtherRAILROAD MEDICARE
FL30503OtherBCBS
FL30503ZMedicare ID - Type Unspecified
E59890Medicare UPIN
FL30303ZMedicare PIN