Provider Demographics
NPI:1811502594
Name:FUJII INNOVATIVE THERAPEUTICS
Entity type:Organization
Organization Name:FUJII INNOVATIVE THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-579-2699
Mailing Address - Street 1:PO BOX 320269
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2269
Mailing Address - Country:US
Mailing Address - Phone:813-579-2699
Mailing Address - Fax:888-508-1859
Practice Address - Street 1:1001 N MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5152
Practice Address - Country:US
Practice Address - Phone:813-579-2699
Practice Address - Fax:888-508-1859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUJII INNOVATIVE THERAPEUTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty