Provider Demographics
NPI:1902015902
Name:PATTANI, KAVITA MALHOTRA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:MALHOTRA
Last Name:PATTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:407-648-3800
Mailing Address - Fax:407-425-5203
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:407-648-3800
Practice Address - Fax:407-425-5203
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPENDING207Y00000X
MDD68821207Y00000X
FLME106709207YX0007X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME106709OtherMEDICAL LICENSE
MD022523100Medicaid
FL002055300Medicaid
MD022523100Medicaid
FLDF969ZMedicare PIN