Provider Demographics
NPI:1932138898
Name:BATHIA, ANIL LAXMIDAS (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:LAXMIDAS
Last Name:BATHIA
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 1:2230 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6100
Mailing Address - Country:US
Mailing Address - Phone:954-753-3800
Mailing Address - Fax:
Practice Address - Street 1:2230 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6100
Practice Address - Country:US
Practice Address - Phone:954-753-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC366502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13772OtherBLUE CROSS BLUE SHIELD
NC561830036OtherFEDERAL TAX ID
FL001631100Medicaid
NC8913772Medicaid
NC13772OtherBLUE CROSS BLUE SHIELD
FLBZ088TMedicare PIN