Provider Demographics
NPI:1114989415
Name:GULANI, SUPARNA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUPARNA
Middle Name:A
Last Name:GULANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8075 GATE PKWY W
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3684
Mailing Address - Country:US
Mailing Address - Phone:904-296-1010
Mailing Address - Fax:904-296-0393
Practice Address - Street 1:8075 GATE PKWY W
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3684
Practice Address - Country:US
Practice Address - Phone:904-296-1010
Practice Address - Fax:904-296-0393
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH96805Medicare UPIN
P00176275Medicare PIN
FL57766AMedicare PIN