Provider Demographics
NPI:1437150349
Name:KANAPARTI, PRAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAVEEN
Middle Name:
Last Name:KANAPARTI
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 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:14534 OLD SAINT AUGUSTINE RD STE 3420
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2616
Practice Address - Country:US
Practice Address - Phone:904-493-8001
Practice Address - Fax:904-338-0852
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94964207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275668400Medicaid
FLP00316397OtherRAILROAD MEDICARE
FLU7030XMedicare PIN
FLP00316397OtherRAILROAD MEDICARE
FLME94964OtherFLORIDA MEDICAL LICENSE
VAH26943Medicare UPIN