Individual
DR. BIBHU DATTA MOHANTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 TAMPA GENERAL CIR FL CIRCLE5, TAMPA, FL 33606-3603
(813) 259-0600
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
ME133637
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022162600
—
FL
01
—
BNQZO
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/30/2008
Last updated
03/30/2021
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