Provider Demographics
NPI:1063486686
Name:SUBRAMANIAN, NANJAPPA (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:NANJAPPA
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:M
Credentials:MD FACS
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Other - Credentials:
Mailing Address - Street 1:2215 NEBRASKA AVE
Mailing Address - Street 2:SUITE 1 E
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4864
Mailing Address - Country:US
Mailing Address - Phone:772-461-2555
Mailing Address - Fax:772-461-0775
Practice Address - Street 1:2215 NEBRASKA AVE
Practice Address - Street 2:SUITE 1 E
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-461-2555
Practice Address - Fax:772-461-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 037901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067226200Medicaid
FL067226200Medicaid
D21775Medicare UPIN