Provider Demographics
NPI:1982693115
Name:KIRTANE, SHIRISH KAMALAKAR (MD)
Entity Type:Individual
Prefix:MR
First Name:SHIRISH
Middle Name:KAMALAKAR
Last Name:KIRTANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 N WESTMONTE DR
Mailing Address - Street 2:STE 1000
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3356
Mailing Address - Country:US
Mailing Address - Phone:407-788-7844
Mailing Address - Fax:407-682-6071
Practice Address - Street 1:210 N. WESTMONTE DR
Practice Address - Street 2:SUITE #1000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714
Practice Address - Country:US
Practice Address - Phone:407-788-7844
Practice Address - Fax:407-682-6071
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038048174400000X
FLME38048207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065694100Medicaid
FL065694100Medicaid
FL47414Medicare PIN