Provider Demographics
NPI:1700947918
Name:NIRMUL, PUSHPA P (MD)
Entity Type:Individual
Prefix:
First Name:PUSHPA
Middle Name:P
Last Name:NIRMUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11260 SULLIVAN ST.
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578
Mailing Address - Country:US
Mailing Address - Phone:813-689-7571
Mailing Address - Fax:813-654-8129
Practice Address - Street 1:11260 SULLIVAN ST.
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578
Practice Address - Country:US
Practice Address - Phone:813-689-7571
Practice Address - Fax:813-654-8129
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038457208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066482100Medicaid
FLD54027Medicare UPIN