Basic Information
| Provider Information | |||||||||
| NPI: | 1649455601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LALANI | ||||||||
| FirstName: | AZIM | ||||||||
| MiddleName: | AKBARALI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2902 59TH ST W | ||||||||
| Address2: | STE C | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342097021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417611998 | ||||||||
| FaxNumber: | 9417982019 | ||||||||
| Practice Location | |||||||||
| Address1: | 7005 CORTEZ RD W | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342102509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417922122 | ||||||||
| FaxNumber: | 9417982019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 04/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301085736 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 4301085736 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | ME 103943 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001160600 | 05 | FL | MEDICAID | 145AY | 01 | FL | BCBS FL | OTHER |