Healthcare Provider Details

I. General information

NPI: 1457538837
Provider Name (Legal Business Name): PUSHPA P NIRMUL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 VONDERBURG DR SUITE 101
BRANDON FL
33511-5900
US

IV. Provider business mailing address

602 VONDERBURG DR SUITE 101
BRANDON FL
33511-5900
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-7571
  • Fax:
Mailing address:
  • Phone: 813-689-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0038457
License Number StateFL

VIII. Authorized Official

Name: DR. PUSHPA P NIRMUL
Title or Position: PRESIDENT
Credential: MD
Phone: 813-689-7571