Provider Demographics
NPI:1437182524
Name:MADNANI, HARISH M (MD)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:M
Last Name:MADNANI
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 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:13911 LAKESHORE BLVD
Practice Address - Street 2:#111
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7102
Practice Address - Country:US
Practice Address - Phone:727-869-8800
Practice Address - Fax:727-869-8814
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10220207R00000X, 174400000X
FLME98999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008157400Medicaid
FLP00984684OtherRR MCR
MS00124091Medicaid
FLP00984684OtherRR MEDICARE
FLEW163YOtherINTERNAL MEDICINE
FL14C9AOtherBCBS
MS00124091Medicaid