Provider Demographics
NPI:1093735383
Name:MADHUSOODANAN, NARAYANAN (MD)
Entity Type:Individual
Prefix:MR
First Name:NARAYANAN
Middle Name:
Last Name:MADHUSOODANAN
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:PO BOX 832017
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34483-2017
Mailing Address - Country:US
Mailing Address - Phone:352-620-9181
Mailing Address - Fax:352-620-9193
Practice Address - Street 1:3304 SE LAKE WEIR AVE
Practice Address - Street 2:STE 3
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8601
Practice Address - Country:US
Practice Address - Phone:352-620-9181
Practice Address - Fax:352-620-9193
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73746207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL363456900Medicaid
FL363456900Medicaid
41595AMedicare ID - Type Unspecified