Provider Demographics
NPI:1922122696
Name:NARA, SREENIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SREENIVAS
Middle Name:
Last Name:NARA
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 1:1101 NW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2531
Mailing Address - Country:US
Mailing Address - Phone:954-682-7565
Mailing Address - Fax:954-476-9248
Practice Address - Street 1:1101 NW 122ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-2531
Practice Address - Country:US
Practice Address - Phone:954-682-7565
Practice Address - Fax:954-476-9248
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85175207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY30512Medicare UPIN
FLI26697Medicare UPIN
FLK7310Medicare ID - Type Unspecified
FLU4384ZMedicare ID - Type Unspecified