Provider Demographics
NPI:1508898255
Name:KADIVAR, TED F (MD PA)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:F
Last Name:KADIVAR
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 2ND ST E
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1029
Mailing Address - Country:US
Mailing Address - Phone:941-744-5860
Mailing Address - Fax:941-744-5681
Practice Address - Street 1:250 2ND ST E
Practice Address - Street 2:SUITE 4C
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1029
Practice Address - Country:US
Practice Address - Phone:941-744-5860
Practice Address - Fax:941-744-5681
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593650291OtherINDIVIDUAL
FL377823100Medicaid
FL27168OtherINDIVIDUAL
FL593650291OtherINDIVIDUAL
FL27168OtherINDIVIDUAL