Provider Demographics
NPI:1740430271
Name:PATWARDHAN, NILIMA A (MD)
Entity type:Individual
Prefix:DR
First Name:NILIMA
Middle Name:A
Last Name:PATWARDHAN
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTINS & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:8931 COLONIAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7809
Practice Address - Country:US
Practice Address - Phone:239-277-0479
Practice Address - Fax:239-277-0729
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38349208600000X
FLME112029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP999460OtherFREEDOM
FL004879700Medicaid
FL14K5XOtherBCBS FL
FL354734OtherAVMED
FLP940525OtherOPTIMUM
FL4317187OtherCIGNA
FL4484632OtherAETNA
FLP01046430OtherRAILROAD MCR
FLP999460OtherFREEDOM