Basic Information
| Provider Information | |||||||||
| NPI: | 1013143189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANAR | ||||||||
| FirstName: | VISHWAS | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 FOWLER GROVE BLVD FL 3 | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347875050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073031812 | ||||||||
| FaxNumber: | 4073031815 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 FOWLER GROVE BLVD FL 3 | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347875050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073031812 | ||||||||
| FaxNumber: | 4073031815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2009 | ||||||||
| LastUpdateDate: | 12/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME135445 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 025176800 | 05 | FL | MEDICAID |