Provider Demographics
NPI:1235150103
Name:RANADIVE, NANDKISHORE VIJAY (MD)
Entity Type:Individual
Prefix:
First Name:NANDKISHORE
Middle Name:VIJAY
Last Name:RANADIVE
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 1:450 W. CENTRAL PKWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-767-8554
Mailing Address - Fax:407-767-9121
Practice Address - Street 1:450 W. CENTRAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-767-8554
Practice Address - Fax:407-767-9121
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62024207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370895100Medicaid
FL370895100Medicaid
FL15218WMedicare PIN