Provider Demographics
NPI:1447214168
Name:SADHWANI, HARISH L (MD)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:L
Last Name:SADHWANI
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 1:12920 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3772
Mailing Address - Country:US
Mailing Address - Phone:772-581-2373
Mailing Address - Fax:772-581-2374
Practice Address - Street 1:12920 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3772
Practice Address - Country:US
Practice Address - Phone:772-581-2373
Practice Address - Fax:772-581-2374
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74025207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255083101Medicaid
G58781Medicare ID - Type Unspecified
FLG58781Medicare UPIN