Provider Demographics
NPI:1932530953
Name:PURANI, GAURAV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:PURANI
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 1:1403 MEDICAL PLAZA DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1085
Mailing Address - Country:US
Mailing Address - Phone:407-328-1575
Mailing Address - Fax:
Practice Address - Street 1:1403 MEDICAL PLAZA DR STE 106
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1085
Practice Address - Country:US
Practice Address - Phone:407-328-1575
Practice Address - Fax:407-328-1577
Is Sole Proprietor?:No
Enumeration Date:2013-12-01
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123574207R00000X, 207R00000X
NJ25MA09488100208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115899200Medicaid
FLPV363OtherHF MA