Healthcare Provider Details

I. General information

NPI: 1124344122
Provider Name (Legal Business Name): KIRANJOT GUJRAL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 HOSPITAL VIEW WAY UNIT B
CLERMONT FL
34711-1920
US

IV. Provider business mailing address

PO BOX 990
WINDERMERE FL
34786-0990
US

V. Phone/Fax

Practice location:
  • Phone: 352-677-9141
  • Fax: 352-549-9379
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME165806
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD19469
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number51123
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: