Provider Demographics
NPI:1649282039
Name:BANDYK, DENNIS FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:FRANCIS
Last Name:BANDYK
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:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:619-543-6980
Mailing Address - Fax:
Practice Address - Street 1:2 TAMPA GENERAL CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3603
Practice Address - Country:US
Practice Address - Phone:813-259-0929
Practice Address - Fax:813-259-0606
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME607512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055247000Medicaid
FL12796OtherBLUE CROSS BLUE SHIELD
FL055247000Medicaid
FL12796OtherBLUE CROSS BLUE SHIELD
FL770000377Medicare PIN