Basic Information
| Provider Information | |||||||||
| NPI: | 1396778510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATILLA | ||||||||
| FirstName: | MEHMET | ||||||||
| MiddleName: | AYDIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1111 12TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330404088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052953535 | ||||||||
| FaxNumber: | 3052946868 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 12TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330404088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052953535 | ||||||||
| FaxNumber: | 3052946868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 06/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9700180 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 9700180 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 97117 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | FH596Y | 01 | FL | MEDICARE INDIVIDUAL PTAN | OTHER | 8901960 | 05 | NC | MEDICAID | 10810 | 01 | NC | BCBS | OTHER | 1467405431 | 01 | NC | GROUP NPI NUMBER | OTHER | 01960 | 01 | NC | BCBS GROUP NUMBER | OTHER | 8910810 | 05 | NC | MEDICAID | FV342A | 01 | FL | MEDICARE GROUP PTAN | OTHER |