Provider Demographics
NPI:1669408910
Name:GOEL, AMITABH (MD)
Entity type:Individual
Prefix:
First Name:AMITABH
Middle Name:
Last Name:GOEL
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 1:8936 77TH TER E UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6419
Mailing Address - Country:US
Mailing Address - Phone:941-923-2500
Mailing Address - Fax:
Practice Address - Street 1:8936 77TH TER E UNIT 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6419
Practice Address - Country:US
Practice Address - Phone:941-923-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS249432081P2900X
FLME773812081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100422340AMedicaid
KS123894OtherCOVENTRY
KS201543OtherHPK
KS100422340AMedicaid
KS102214OtherBCBS
KS14210OtherPHS
KS102214Medicare ID - Type Unspecified