Provider Demographics
NPI:1508866609
Name:MEDARA, ARUNA (MD)
Entity Type:Individual
Prefix:
First Name:ARUNA
Middle Name:
Last Name:MEDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARUNA
Other - Middle Name:
Other - Last Name:BIKKASANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13470 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6820
Mailing Address - Country:US
Mailing Address - Phone:352-597-0016
Mailing Address - Fax:352-597-0089
Practice Address - Street 1:13470 TAFT ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-0016
Practice Address - Fax:352-597-0089
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00479072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370404100Medicaid
FL370404100Medicaid
D50434Medicare UPIN