MEDICARE: SUNDEEP MEDIRATTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME85297	FL
2	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	ME85297	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME85297	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1366403867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNDEEP MEDIRATTA MD

Provider Business Mailing Address
First Line	:	1723 LUCERNE TER STE 100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2916
Country	:	US
Telephone Number	:	407-738-4200
Fax Number	:	407-650-1307

Provider Business Practice Location Address
First Line	:	805 OAKLEY SEAVER DR STE A
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1968
Country	:	US
Telephone Number	:	407-738-4200
Fax Number	:	407-705-2540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	11/28/2023

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Directions to “ SUNDEEP MEDIRATTA MD” Practice Location

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