Provider Demographics
NPI:1932211158
Name:PURANIK, SUBHASH RAMCHANDRA (MD)
Entity Type:Individual
Prefix:MR
First Name:SUBHASH
Middle Name:RAMCHANDRA
Last Name:PURANIK
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 1:300 NW 70TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2384
Mailing Address - Country:US
Mailing Address - Phone:954-584-8500
Mailing Address - Fax:954-792-0192
Practice Address - Street 1:300 NW 70TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2384
Practice Address - Country:US
Practice Address - Phone:954-584-8500
Practice Address - Fax:954-792-0192
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059193900Medicaid
FL059193900Medicaid