1124083514 NPI number — GIAVONNE D RONDO-HILLMAN MD

Table of content: GIAVONNE D RONDO-HILLMAN MD (NPI 1124083514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124083514 NPI number — GIAVONNE D RONDO-HILLMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RONDO-HILLMAN
Provider First Name:
GIAVONNE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RONDO
Provider Other First Name:
GIAVONNE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124083514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 BLUE LAGOON DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33126-3168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-500-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 VETERANS PKWY STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47129-2390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-668-8144
Provider Business Practice Location Address Fax Number:
877-772-5243
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01056457A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 39559 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000243727 . This is a "ANTHEM FOR NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2447471000 . This is a "PASS ADVANTAGE FOR NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2004123330 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100019410 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017039 . This is a "SIHO / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110244199 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1200861 . This is a "CHA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89821218-001 . This is a "CIGNA / NCMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000023034C . This is a "HUMANA FOR NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50006203 . This is a "PASSPORT FOR NCMA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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