Individual
MANJUL DILIPBHAI DERASARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
36763 EILAND BLVD STE 201, ZEPHYRHILLS, FL 33542
(813) 977-6688
(813) 355-5060
Mailing address
38135 MARKET SQ, ZEPHYRHILLS, FL 33542-7505
(352) 567-0188
(813) 355-5084
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
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