Provider Demographics
NPI:1265824064
Name:JANIVARA UMESH MD
Entity Type:Organization
Organization Name:JANIVARA UMESH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANIVARA
Authorized Official - Middle Name:
Authorized Official - Last Name:UMESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-646-7220
Mailing Address - Street 1:1350 E MAIN ST
Mailing Address - Street 2:SUITE C1
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-5065
Mailing Address - Country:US
Mailing Address - Phone:863-646-7220
Mailing Address - Fax:863-533-0333
Practice Address - Street 1:1350 E MAIN ST
Practice Address - Street 2:SUITE C1
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5065
Practice Address - Country:US
Practice Address - Phone:863-646-7220
Practice Address - Fax:863-533-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0041112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53709OtherFLORIDA BLUE