Provider Demographics
NPI:1457375479
Name:BHATIA, ANIL M (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:M
Last Name:BHATIA
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 1:2106 CHESTNUT FOREST DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14447 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2862
Practice Address - Country:US
Practice Address - Phone:813-975-1501
Practice Address - Fax:813-975-1505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0073647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
542087068OtherTAX ID
2077393OtherCIGNA
FL253294800Medicaid
ME0073647OtherMEDICAL LIC
42270BOtherBCBS
542087068OtherTRICARE
594572OtherAVMED
542087068OtherHUMANA
04-10158OtherUNITED HEALTHCARE
10334501OtherCITRUS
542087068OtherAETNA
N266961OtherWELLCARE
N266961OtherWELLCARE
FL253294800Medicaid