Healthcare Provider Details

I. General information

NPI: 1235150103
Provider Name (Legal Business Name): NANDKISHORE VIJAY RANADIVE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W. CENTRAL PKWY SUITE 2000
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

450 W. CENTRAL PKWY SUITE 2000
ALTAMONTE SPRINGS FL
32714
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-8554
  • Fax: 407-767-9121
Mailing address:
  • Phone: 407-767-8554
  • Fax: 407-767-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME62024
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: