1104894427 NPI number — ARUNACHALAM JOTHIVIJAYARANI M.D.

Table of content: ARUNACHALAM JOTHIVIJAYARANI M.D. (NPI 1104894427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104894427 NPI number — ARUNACHALAM JOTHIVIJAYARANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOTHIVIJAYARANI
Provider First Name:
ARUNACHALAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOTHIVIJAYARANI
Provider Other First Name:
A.
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104894427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4216 CORTEZ RD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34210-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-527-9929
Provider Business Mailing Address Fax Number:
941-500-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4216 CORTEZ RD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34210-3121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-500-3100
Provider Business Practice Location Address Fax Number:
941-500-3113
Provider Enumeration Date:
03/11/2006

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: 207V00000X , with the licence number:  ME93841 , 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: 296991 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 306370 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 29211 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273149500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09124 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 113522800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2209708 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 113522800 . 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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