Provider Demographics
NPI:1518956085
Name:KIRTANE, PRAFULLA KAMALAKAR (MD)
Entity Type:Individual
Prefix:MR
First Name:PRAFULLA
Middle Name:KAMALAKAR
Last Name:KIRTANE
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:P.O. BOX 160127
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0127
Mailing Address - Country:US
Mailing Address - Phone:407-788-7844
Mailing Address - Fax:407-682-6071
Practice Address - Street 1:210 N. WESTMONTE DR
Practice Address - Street 2:SUITE #1000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-788-7844
Practice Address - Fax:407-682-6071
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037121174400000X
FLME37121207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065091900Medicaid
FLD55032Medicare UPIN
FL47373Medicare PIN