Provider Demographics
NPI:1699040444
Name:IYENGAR, KAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:IYENGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7605
Mailing Address - Country:US
Mailing Address - Phone:850-785-4344
Mailing Address - Fax:850-785-0842
Practice Address - Street 1:1827 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7605
Practice Address - Country:US
Practice Address - Phone:850-785-4344
Practice Address - Fax:850-785-0842
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093498207X00000X
ALMD.31765207XX0004X
FLME117402207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery