Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | ME0062422 | FL |
NPI | 1093769549 |
---|---|
Provider Name | Dr. Antony G Sankoorikal |
First Address | Clearwater, FL 33761-3167 |
Second Address | Clearwater, FL 33761-3167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25145 | BCBS (01) | FL |
375377800 | (05) | FL |
F15040 | (02) | FL |
P00030228 | RR MEDICARE (01) | FL |