Healthcare Provider Details

I. General information

NPI: 1780682575
Provider Name (Legal Business Name): KALPANA S. DESHMUKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 CLEVELAND AVE
FORT MYERS FL
33901-5864
US

IV. Provider business mailing address

PO BOX 1710 SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
VOORHEES NJ
08043-7710
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-2000
  • Fax: 856-751-0535
Mailing address:
  • Phone: 856-770-0504
  • Fax: 856-770-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA04036100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME125789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: