Provider Demographics
NPI:1700831179
Name:RENUKA SWAMINATHAN M.D.,P.A
Entity Type:Organization
Organization Name:RENUKA SWAMINATHAN M.D.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENUKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAMINATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-629-2250
Mailing Address - Street 1:150 SE 17TH ST
Mailing Address - Street 2:SUITE#504
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5178
Mailing Address - Country:US
Mailing Address - Phone:352-629-2250
Mailing Address - Fax:352-629-0056
Practice Address - Street 1:150 SE 17TH ST
Practice Address - Street 2:SUITE#504
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5178
Practice Address - Country:US
Practice Address - Phone:352-629-2250
Practice Address - Fax:352-629-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261003500Medicaid
G04961Medicare UPIN
FL35371Medicare PIN