Provider Demographics
NPI:1609195833
Name:HANUMANTHAPPA, NANDHEESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDHEESHA
Middle Name:
Last Name:HANUMANTHAPPA
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 1:3221 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8002
Mailing Address - Country:US
Mailing Address - Phone:941-505-8720
Mailing Address - Fax:941-505-8747
Practice Address - Street 1:3221 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8002
Practice Address - Country:US
Practice Address - Phone:941-505-8720
Practice Address - Fax:941-505-8747
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116075207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01197128OtherRR MEDICARE
FL14R6ZOtherBCFL
FLHI186ZMedicare PIN