Individual
MANJUL DILIPBHAI DERASARI
Active
Individual
MANJUL DILIPBHAI DERASARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME0054111
FL
208VP0014X
Interventional Pain Medicine Physician
Primary
ME54111
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064751900
—
FL
01
—
11609R
MEDICARE PTAN
FL
01
—
39715
MEDICARE PTAN GROUP
FL
Enumeration date
04/05/2006
Last updated
06/17/2022
Update your record
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