Basic Information
| Provider Information | |||||||||
| NPI: | 1629245733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SREEKANTAN | ||||||||
| FirstName: | MITHUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12493 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331012493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055855315 | ||||||||
| FaxNumber: | 3053552242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 NW 12TH AVE # 600A | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055856856 | ||||||||
| FaxNumber: | 3053552244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2008 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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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 | 207R00000X | 25325 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 25325 | NE | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | ME134768 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.