Provider Demographics
NPI:1013081520
Name:GANDRETI, NAVEEN SUNDHER (MD)
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:SUNDHER
Last Name:GANDRETI
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 1:3601 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3300
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:1600 SOUTH ANDREWS AVE.
Practice Address - Street 2:BROWARD HEALTH MEDICAL CENTER
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-355-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124872207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NG073993OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26218124Medicare ID - Type Unspecified
MI482167510Medicaid
NG073993OtherCHAMPUS-CHAMPUS
050H262180OtherBLUE CROSS-BLUE CROSS
I48834Medicare UPIN