Basic Information
| Provider Information | |||||||||
| NPI: | 1821184615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAYANI | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | MANALILI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 862506 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137540467 | ||||||||
| FaxNumber: | 9133415797 | ||||||||
| Practice Location | |||||||||
| Address1: | 2901 W. SWANN AVE. | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137540467 | ||||||||
| FaxNumber: | 9133415797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 06/10/2008 | ||||||||
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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 | 207L00000X | ME27256 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 036042200 | 05 | FL | MEDICAID | 050076795 | 01 | FL | RAILROAD MEDICARE | OTHER | 30503 | 01 | FL | BCBS | OTHER |