Provider Demographics
NPI:1235189457
Name:KISNAD, HITEN VITHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:HITEN
Middle Name:VITHAL
Last Name:KISNAD
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 1:3840 BELFORT RD STE 306
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8210
Mailing Address - Country:US
Mailing Address - Phone:904-854-9177
Mailing Address - Fax:904-854-6696
Practice Address - Street 1:3840 BELFORT RD STE 306
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8210
Practice Address - Country:US
Practice Address - Phone:904-854-9177
Practice Address - Fax:904-854-6696
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME664822084P0800X
FLME00664822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377054100Medicaid
K3767Medicare ID - Type UnspecifiedGROUP MEDICARE
FL377054100Medicaid
26530XMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE