Provider Demographics
NPI:1407894132
Name:MITHANI, VIMESH KIRITKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VIMESH
Middle Name:KIRITKUMAR
Last Name:MITHANI
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:PO BOX 1746
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1746
Mailing Address - Country:US
Mailing Address - Phone:727-786-1000
Mailing Address - Fax:727-786-1055
Practice Address - Street 1:2676 W LAKE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3120
Practice Address - Country:US
Practice Address - Phone:727-786-1000
Practice Address - Fax:727-786-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93842207RC0000X
NJ25MA07293100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276578100Medicaid
P00376661OtherRRW MCR
P00376661OtherRRW MCR
FLAB237ZMedicare ID - Type Unspecified