Provider Demographics
NPI:1265429500
Name:PURANDARE, VINAYAK V (MD)
Entity type:Individual
Prefix:
First Name:VINAYAK
Middle Name:V
Last Name:PURANDARE
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 1:305 MEMORIAL MEDICAL PARKWAY, SUITE 507
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-672-8595
Mailing Address - Fax:386-677-4987
Practice Address - Street 1:305 MEMORIAL MEDICAL PARKWAY, SUITE 507
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-672-8595
Practice Address - Fax:386-677-4987
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RN0300X207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048136000Medicaid
FLD21057Medicare UPIN
FL05789YMedicare ID - Type UnspecifiedMEDICARE