Provider Demographics
NPI:1659386449
Name:RAXWAL, VINOD K (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:K
Last Name:RAXWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5305
Mailing Address - Fax:352-616-0926
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7180
Practice Address - Country:US
Practice Address - Phone:727-857-4871
Practice Address - Fax:727-857-4894
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101179207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101179OtherSTATE MEDIAL LICENSE
FL000278100Medicaid
FL61908OtherBCBS FL
FL61908OtherBCBS FL
FLAN840WMedicare PIN
FLAN840XMedicare PIN
FL000278100Medicaid