Provider Demographics
NPI:1942211370
Name:MAINI, ARCHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:MAINI
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 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-355-4975
Mailing Address - Fax:954-355-5898
Practice Address - Street 1:1625 SE 3RD AVE STE 525
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-355-4975
Practice Address - Fax:954-355-5898
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL97693207RH0003X
FLME97695207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02211347Medicaid
FL277439900Medicaid
FLH52244Medicare UPIN
FL277439900Medicaid