1811180870 NPI number — NANDINI KIRI MD PA

Table of content: (NPI 1811180870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811180870 NPI number — NANDINI KIRI MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NANDINI KIRI MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811180870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 495237
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33949-5237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-883-5454
Provider Business Mailing Address Fax Number:
941-883-5457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3390 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-8157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-883-5454
Provider Business Practice Location Address Fax Number:
941-883-5457
Provider Enumeration Date:
08/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIRI
Authorized Official First Name:
NANDINI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
941-883-5454

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  ME82594 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05106 . This is a "BCBS FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 26157710 . This is a "MEDICAID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00058990 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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