Provider Demographics
NPI:1629387980
Name:NIBHA MEDIRATTA MD PL
Entity Type:Organization
Organization Name:NIBHA MEDIRATTA MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-274-1864
Mailing Address - Street 1:PO BOX 991
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0985
Mailing Address - Country:US
Mailing Address - Phone:321-274-1864
Mailing Address - Fax:352-243-3044
Practice Address - Street 1:1950 HOSPITAL VIEW WAY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1926
Practice Address - Country:US
Practice Address - Phone:352-243-3443
Practice Address - Fax:352-243-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty