Basic Information
| Provider Information | |||||||||
| NPI: | 1437182524 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADNANI | ||||||||
| FirstName: | HARISH | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14690 SPRING HILL DR | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346098102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527990046 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 13911 LAKESHORE BLVD | ||||||||
| Address2: | #111 | ||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346677102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278698800 | ||||||||
| FaxNumber: | 7278698814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 07/07/2016 | ||||||||
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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 | 174400000X | 10220 | MS | N | Other Service Providers | Specialist | 207R00000X | 10220 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME98999 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00124091 | 05 | MS | MEDICAID | 14C9A | 01 | FL | BCBS | OTHER | EW163Z | 01 | FL | MEDICARE PROVIDER NUMBER | OTHER | P00984684 | 01 | FL | RR MCR | OTHER | P00984684 | 01 | FL | RR MEDICARE | OTHER |