Provider Demographics
NPI:1083655716
Name:SONPAVDE, GURU P (MD)
Entity Type:Individual
Prefix:DR
First Name:GURU
Middle Name:P
Last Name:SONPAVDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 689
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4648
Mailing Address - Country:US
Mailing Address - Phone:407-303-2024
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 689
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4648
Practice Address - Country:US
Practice Address - Phone:407-303-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7567207RH0003X
MA271600207RH0000X, 207RX0202X
FLME154902207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163866007Medicaid
TX163866004Medicaid
TX163866006Medicaid
TX163866005Medicaid
TX8R1554OtherBLUE CROSS OF TEXAS
TX163866003Medicaid
TX163866003Medicaid
TX8C2269Medicare PIN
TXG87712Medicare PIN
TXP00126721Medicare PIN
TX163866005Medicaid
TX8G9674Medicare PIN