Provider Demographics
NPI:1700221348
Name:SOUTH FLORIDA INTERNAL MEDICINE GROUP INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA INTERNAL MEDICINE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAGOPALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-899-6739
Mailing Address - Street 1:10006 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3938
Mailing Address - Country:US
Mailing Address - Phone:954-899-6739
Mailing Address - Fax:
Practice Address - Street 1:10006 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-3938
Practice Address - Country:US
Practice Address - Phone:954-899-6739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004803800Medicaid
FL02860VMedicare UPIN