Provider Demographics
NPI:1811180870
Name:NANDINI KIRI MD PA
Entity type:Organization
Organization Name:NANDINI KIRI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NANDINI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:941-883-5454
Mailing Address - Street 1:PO BOX 495237
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5237
Mailing Address - Country:US
Mailing Address - Phone:941-883-5454
Mailing Address - Fax:941-883-5457
Practice Address - Street 1:3390 TAMIAMI TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8157
Practice Address - Country:US
Practice Address - Phone:941-883-5454
Practice Address - Fax:941-883-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82594207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05106OtherBCBS FL
FL26157710OtherMEDICAID
FLP00058990OtherRR MEDICARE
FLE5910Medicare PIN
FLFK915AMedicare PIN