Provider Demographics
NPI:1871511469
Name:BRAR, SARDUL S (MD)
Entity Type:Individual
Prefix:
First Name:SARDUL
Middle Name:S
Last Name:BRAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 CO RD 17A WEST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825
Mailing Address - Country:US
Mailing Address - Phone:873-452-3060
Mailing Address - Fax:863-452-3069
Practice Address - Street 1:109 WEST WALL STREET
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843
Practice Address - Country:US
Practice Address - Phone:863-635-4891
Practice Address - Fax:863-635-3545
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049241800Medicaid
51277OtherBCBS FL
FL049241800Medicaid
FL51277Medicare PIN
FLD21707Medicare Oscar/Certification
FL51277AMedicare PIN
51277OtherBCBS FL
FL51277CMedicare PIN