Provider Demographics
NPI:1124287511
Name:ANEJA, PARUL (MD)
Entity type:Individual
Prefix:
First Name:PARUL
Middle Name:
Last Name:ANEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N HABANA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7107
Mailing Address - Country:US
Mailing Address - Phone:813-450-3457
Mailing Address - Fax:724-204-1852
Practice Address - Street 1:4620 N HABANA AVE STE 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-450-3457
Practice Address - Fax:724-204-1852
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050029207R00000X
WI54589-20207RI0200X
FLME117640207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1124287511Medicaid
WI07010/0332Medicare PIN