Basic Information
| Provider Information | |||||||||
| NPI: | 1407956725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIBHANUPUDY | ||||||||
| FirstName: | BOBBY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NIBHANUPUDY | ||||||||
| OtherFirstName: | LAKSHMI | ||||||||
| OtherMiddleName: | NARASIMHA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2415 N ORANGE AVE SUITE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2415 N ORANGE AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328045521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073032474 | ||||||||
| FaxNumber: | 4073030680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| 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 | 208600000X | ME84158 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | ME84158 | FL | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
No ID Information.