Provider Demographics
NPI:1376634311
Name:BHALLA, MEENAKSHI AWASTHI (MD)
Entity type:Individual
Prefix:DR
First Name:MEENAKSHI
Middle Name:AWASTHI
Last Name:BHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W DR MLK BLVD FL JR2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6307
Mailing Address - Country:US
Mailing Address - Phone:813-397-1251
Mailing Address - Fax:813-443-8136
Practice Address - Street 1:3003 W DR MARTIN LUTHER KING JR BLVD FL 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6307
Practice Address - Country:US
Practice Address - Phone:813-397-1251
Practice Address - Fax:813-443-8136
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49149207R00000X, 207RA0001X, 207RC0000X
FLME145175207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107106800Medicaid