Provider Demographics
NPI:1750440020
Name:PANDYA, KAMLESH PRANSHANKER (MD)
Entity type:Individual
Prefix:DR
First Name:KAMLESH
Middle Name:PRANSHANKER
Last Name:PANDYA
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 1:2100 NEBRASKA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4832
Mailing Address - Country:US
Mailing Address - Phone:772-460-1510
Mailing Address - Fax:772-460-1509
Practice Address - Street 1:2100 NEBRASKA AVE STE 202
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4832
Practice Address - Country:US
Practice Address - Phone:772-460-1510
Practice Address - Fax:772-460-1509
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059031207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051911100Medicaid
FL051911100Medicaid
FL11806Medicare ID - Type Unspecified