Basic Information
| Provider Information | |||||||||
| NPI: | 1346511615 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAJNIKANT M. KADIWAR, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3015 LAKELAND HIGHLANDS RD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338034339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636827737 | ||||||||
| FaxNumber: | 8636820761 | ||||||||
| Practice Location | |||||||||
| Address1: | 3015 LAKELAND HIGHLANDS RD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338034339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636827737 | ||||||||
| FaxNumber: | 8636820761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2012 | ||||||||
| LastUpdateDate: | 01/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | KADIWAR | ||||||||
| AuthorizedOfficialFirstName: | JAYSHRI | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8636827737 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME0067835 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 378086401 | 05 | FL | MEDICAID | 27337 | 01 | BCBS OF FL | OTHER |