Basic Information
| Provider Information | |||||||||
| NPI: | 1770503252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARCHANDANI | ||||||||
| FirstName: | PREETI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4312 DUCK DOWN LN | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338843293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636798000 | ||||||||
| FaxNumber: | 8636798008 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 S 11TH ST | ||||||||
| Address2: | |||||||||
| City: | LAKE WALES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338534202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636798000 | ||||||||
| FaxNumber: | 8636798008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 12/20/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME85714 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51547 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |