Provider Demographics
NPI:1700885688
Name:DHARMAPPA, KABBINAMANE V (MD)
Entity Type:Individual
Prefix:DR
First Name:KABBINAMANE
Middle Name:V
Last Name:DHARMAPPA
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 1:1319 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1809
Mailing Address - Country:US
Mailing Address - Phone:954-452-7576
Mailing Address - Fax:
Practice Address - Street 1:1319 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1809
Practice Address - Country:US
Practice Address - Phone:954-452-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065783200Medicaid
FL200363OtherAMERIGROUP
FL93929OtherBLUE CROSS BLUE SHIELD
FLME0037089OtherVISTA HEALTH PLANS
FL209967OtherAVMED
FL4220597OtherAETNA
FL209967OtherAVMED