Provider Demographics
NPI:1942253778
Name:PADMANABH, MUNIVENKATAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNIVENKATAPPA
Middle Name:
Last Name:PADMANABH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUNI
Other - Middle Name:V
Other - Last Name:PADMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:601 E DIXIE AVE
Mailing Address - Street 2:PLAZA 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34718
Mailing Address - Country:US
Mailing Address - Phone:352-326-8081
Mailing Address - Fax:352-326-5084
Practice Address - Street 1:601 E DIXIE AVE
Practice Address - Street 2:PLAZA 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5953
Practice Address - Country:US
Practice Address - Phone:352-326-8081
Practice Address - Fax:352-326-5084
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35184Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
FLE34374Medicare UPIN