Provider Demographics
NPI:1497853816
Name:KIRDNUAL, AMNATH (MD)
Entity Type:Individual
Prefix:
First Name:AMNATH
Middle Name:
Last Name:KIRDNUAL
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 1:201 HEALTH PARK BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-824-2508
Mailing Address - Fax:904-824-3566
Practice Address - Street 1:201 HEALTH PARK BLVD
Practice Address - Street 2:STE 211
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-824-2508
Practice Address - Fax:904-824-3566
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0042173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067776100Medicaid
FL067776100Medicaid
61030Medicare ID - Type Unspecified