Provider Demographics
NPI:1215330824
Name:GULF TO BAY INFECTIOUS DISEASE CONSULTANTS PLLC
Entity type:Organization
Organization Name:GULF TO BAY INFECTIOUS DISEASE CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUDATHIRU
Authorized Official - Middle Name:
Authorized Official - Last Name:BUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-541-1466
Mailing Address - Street 1:PO BOX 320546
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2546
Mailing Address - Country:US
Mailing Address - Phone:813-541-1466
Mailing Address - Fax:888-249-3323
Practice Address - Street 1:4129 W KENNEDY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2254
Practice Address - Country:US
Practice Address - Phone:813-541-1466
Practice Address - Fax:888-249-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-28
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 111588207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL505412Medicaid
FL165984Medicare UPIN