Provider Demographics
NPI:1053702589
Name:KANTILAL N. BHADJA, MD
Entity type:Organization
Organization Name:KANTILAL N. BHADJA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KANTILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BHADJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-839-5253
Mailing Address - Street 1:4223 W. EL PRADO BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629
Mailing Address - Country:US
Mailing Address - Phone:813-839-5253
Mailing Address - Fax:813-839-2953
Practice Address - Street 1:4223 W. EL PRADO BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629
Practice Address - Country:US
Practice Address - Phone:813-839-5253
Practice Address - Fax:813-839-2953
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANTILAL N. BHADJA, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48738207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty