Provider Demographics
NPI:1295719300
Name:PADALIA, JITENDRA G (MD)
Entity type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:G
Last Name:PADALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JITENDRA
Other - Middle Name:G
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 452198
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-2198
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:
Practice Address - Street 1:2173A CENTERVILLE PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4356
Practice Address - Country:US
Practice Address - Phone:850-385-0144
Practice Address - Fax:850-385-0146
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34721207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37258OtherBCBS OF FL
FL37258ZMedicare PIN
D34601Medicare UPIN