Provider Demographics
NPI:1861464596
Name:DESHPANDE, KRISHNARAJ GOPAL (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISHNARAJ
Middle Name:GOPAL
Last Name:DESHPANDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0417
Mailing Address - Country:US
Mailing Address - Phone:772-223-5665
Mailing Address - Fax:772-223-5646
Practice Address - Street 1:200 SE HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2346
Practice Address - Country:US
Practice Address - Phone:772-223-5628
Practice Address - Fax:772-223-5652
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2515842OtherUNITED HEALTHCARE
NC5900619Medicaid
NC805410OtherPARTNERS
FL14TP5OtherFLORIDA BLUE
NC2335816OtherMEDICARE PTAN - GROUP
NC2402381DOtherMEDICARE PTAN - INDIVIDUAL
NCE0721OtherMEDCOST
NC138VKOtherBCBS OF NC
NC7613628OtherAETNA
FL010555700Medicaid
FL010555700Medicaid
NC2402381Medicare PIN
NCE0721OtherMEDCOST