Provider Demographics
NPI:1588632111
Name:KIDWAI, ARIF SALAH (MD)
Entity type:Individual
Prefix:DR
First Name:ARIF
Middle Name:SALAH
Last Name:KIDWAI
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 1:283 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-8358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:283 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-8358
Practice Address - Country:US
Practice Address - Phone:904-686-9713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME901332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269673800Medicaid
GA760962350AMedicaid
FLP00128609OtherRAILROAD MEDICARE
FLP00848653OtherRAILROAD MEDICARE
FLP00848653OtherRAILROAD MEDICARE
FL43144YMedicare UPIN
GA760962350AMedicaid