Provider Demographics
NPI:1033306394
Name:LOAKHNAUTH RAMKISHUN MD PA
Entity Type:Organization
Organization Name:LOAKHNAUTH RAMKISHUN MD PA
Other - Org Name:INTERNAL MEDICINE OF VERANDA PARK PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOAKHNAUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMKISHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-291-2620
Mailing Address - Street 1:6150 METROWEST BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3289
Mailing Address - Country:US
Mailing Address - Phone:407-291-2620
Mailing Address - Fax:407-291-2625
Practice Address - Street 1:6150 METROWEST BLVD
Practice Address - Street 2:STE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3289
Practice Address - Country:US
Practice Address - Phone:407-291-2620
Practice Address - Fax:407-291-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6491Medicare PIN