Provider Demographics
NPI:1477500338
Name:ADI, ASHISH MADHUKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:MADHUKAR
Last Name:ADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-985-1925
Mailing Address - Fax:239-468-7929
Practice Address - Street 1:16271 BASS RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3616
Practice Address - Country:US
Practice Address - Phone:239-985-1925
Practice Address - Fax:239-468-7929
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93123207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272447200Medicaid
P00237306OtherRAILROAD MEDICARE
FL05536OtherBCBS
FL5101320OtherCIGNA
FLP01319829OtherRR MEDICARE
FL7988757OtherAETNA
FLP203140OtherOPTIMUM
FLP304612OtherFREEDOM
FL307162OtherAVMED
FL272447200Medicaid
FL5101320OtherCIGNA
FL05526XMedicare PIN
FLP203140OtherOPTIMUM