Provider Demographics
NPI:1710205661
Name:CALADIUM PEDIATRICS
Entity Type:Organization
Organization Name:CALADIUM PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAVATTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAGHUVEERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-699-5437
Mailing Address - Street 1:77 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9571
Mailing Address - Country:US
Mailing Address - Phone:863-699-5437
Mailing Address - Fax:863-699-9000
Practice Address - Street 1:77 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9571
Practice Address - Country:US
Practice Address - Phone:863-699-5437
Practice Address - Fax:863-699-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-16
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83514208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002108800Medicaid