Healthcare Provider Details

I. General information

NPI: 1679528111
Provider Name (Legal Business Name): RADHIKA RANGANATHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 CYPRESS RIDGE BLVD
WESLEY CHAPEL FL
33544-6335
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-920-1800
  • Fax: 813-635-2613
Mailing address:
  • Phone: 727-532-1355
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 85950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: