Provider Demographics
NPI:1548664899
Name:NARIMAN NIKTASH MD PA
Entity type:Organization
Organization Name:NARIMAN NIKTASH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKTASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-258-4491
Mailing Address - Street 1:PO BOX 495009
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5009
Mailing Address - Country:US
Mailing Address - Phone:941-258-4491
Mailing Address - Fax:941-206-6418
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:941-258-4491
Practice Address - Fax:941-206-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty