Provider Demographics
NPI:1598217507
Name:DR GIDWANI M D LLC
Entity Type:Organization
Organization Name:DR GIDWANI M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-443-9264
Mailing Address - Street 1:3920 SW 186TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2720
Mailing Address - Country:US
Mailing Address - Phone:844-443-9264
Mailing Address - Fax:
Practice Address - Street 1:3920 SW 186TH WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2720
Practice Address - Country:US
Practice Address - Phone:844-443-9264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111199207Q00000X
FLME109293207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty