1174839476 NPI number — KIRTANE ASSOCIATES M.D., P.A.

Table of content: (NPI 1174839476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174839476 NPI number — KIRTANE ASSOCIATES M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRTANE ASSOCIATES M.D., P.A.
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:
1174839476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 160127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32716-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-788-7844
Provider Business Mailing Address Fax Number:
407-682-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 N WESTMONTE DR
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-788-7844
Provider Business Practice Location Address Fax Number:
407-682-6071
Provider Enumeration Date:
08/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KIRTANE
Authorized Official First Name:
SHIRISH
Authorized Official Middle Name:
KAMALAKAR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-788-7844

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  ME37121 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: ME38048 , 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: ME38048 . This is a "LISCENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 065694100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 065091900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME37121 . This is a "LISCENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009722900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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