1710945761 NPI number — RATAN K AHUJA MD FACC

Table of content: RATAN K AHUJA MD FACC (NPI 1710945761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710945761 NPI number — RATAN K AHUJA MD FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHUJA
Provider First Name:
RATAN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD FACC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AHUJA
Provider Other First Name:
RATAN
Provider Other Middle Name:
K
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:
1710945761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32885-0168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-456-0300
Provider Business Mailing Address Fax Number:
386-456-0303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
759 HARLEY STRICKLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-7954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-456-0300
Provider Business Practice Location Address Fax Number:
386-456-0303
Provider Enumeration Date:
05/01/2006

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: 207RC0000X , with the licence number:  ME74681 , 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: 257333400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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