Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | ME85297 | FL |
N | 207RC0000X | Internist - Cardiovascular Disease | ME85297 | FL |
NPI | 1366403867 |
---|---|
Provider Name | Sundeep Mediratta |
First Address | Clermont, FL 34711-1962 |
Second Address | Clermont, FL 34711-1962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 22/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265507100 | (05) | FL |
ME85297 | MEDICAL LICENSE (01) | FL |