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:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 HEALTH PARK BLVD
Mailing Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5784
Mailing Address - Country:US
Mailing Address - Phone:904-819-4398
Mailing Address - Fax:904-819-4976
Practice Address - Street 1:400 HEALTH PARK BLVD
Practice Address - Street 2:ATTN: RADIOLOGY DEPARTMENT
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5784
Practice Address - Country:US
Practice Address - Phone:904-819-4398
Practice Address - Fax:904-819-4976
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME901332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00848653OtherRAILROAD MEDICARE
GA760962350AMedicaid
FL269673800Medicaid
FLP00128609OtherRAILROAD MEDICARE
FLP00848653OtherRAILROAD MEDICARE
FL43144YMedicare UPIN
GA760962350AMedicaid