Provider Demographics
NPI:1891554820
Name:FUNCTIONAL AND INTERVENTIONAL GASTROENTEROLOGY PLLC
Entity Type:Organization
Organization Name:FUNCTIONAL AND INTERVENTIONAL GASTROENTEROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANJEEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-364-4863
Mailing Address - Street 1:PO BOX 273391
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-3391
Mailing Address - Country:US
Mailing Address - Phone:813-364-8863
Mailing Address - Fax:813-738-4889
Practice Address - Street 1:10004 N DALE MABRY HWY STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4421
Practice Address - Country:US
Practice Address - Phone:813-364-8863
Practice Address - Fax:813-738-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty