Provider Demographics
NPI:1346511615
Name:RAJNIKANT M. KADIWAR, MD
Entity Type:Organization
Organization Name:RAJNIKANT M. KADIWAR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYSHRI
Authorized Official - Middle Name:
Authorized Official - Last Name:KADIWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-682-7737
Mailing Address - Street 1:3015 LAKELAND HIGHLANDS RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4339
Mailing Address - Country:US
Mailing Address - Phone:863-682-7737
Mailing Address - Fax:863-682-0761
Practice Address - Street 1:3015 LAKELAND HIGHLANDS RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4339
Practice Address - Country:US
Practice Address - Phone:863-682-7737
Practice Address - Fax:863-682-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378086401Medicaid
27337OtherBCBS OF FL
FL378086401Medicaid