Healthcare Provider Details

I. General information

NPI: 1881273217
Provider Name (Legal Business Name): RAGHAV MADAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 N HANCOCK RD STE 220
MINNEOLA FL
34715-8182
US

IV. Provider business mailing address

1820 N HANCOCK RD STE 220
MINNEOLA FL
34715-8182
US

V. Phone/Fax

Practice location:
  • Phone: 689-289-2650
  • Fax:
Mailing address:
  • Phone: 689-289-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME174838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: