Provider Demographics
NPI:1205920444
Name:VITA ANKSH M D P A
Entity type:Organization
Organization Name:VITA ANKSH M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:VITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANKSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-254-1316
Mailing Address - Street 1:PO BOX 110465
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0108
Mailing Address - Country:US
Mailing Address - Phone:239-254-1316
Mailing Address - Fax:
Practice Address - Street 1:9010 STRADA STELL CT
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4424
Practice Address - Country:US
Practice Address - Phone:239-254-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83804207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265813500Medicaid
FLH51733Medicare UPIN
FL265813500Medicaid