Basic Information
| Provider Information | |||||||||
| NPI: | 1144482597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAIR | ||||||||
| FirstName: | REJI | ||||||||
| MiddleName: | RADHAKRISHNAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3885 OAKWATER CIR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328066257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078516226 | ||||||||
| FaxNumber: | 4074380507 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 HARTMAN RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349474412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724651170 | ||||||||
| FaxNumber: | 7724651171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | TP120 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | ME111887 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 014673900 | 05 | FL | MEDICAID |