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General NPI Number Information
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NPI Number | 1043710981
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Entity Type | Individual
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Provider Name | VIDUR PRAVIN GHANTIWALA DO
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Gender | Male
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 4513 EXECUTIVE DR
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City | NAPLES
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State | FL
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Zip | 34119-9033
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Country | US
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Telephone | 239-591-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 EXECUTIVE DR
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City | NAPLES
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State | FL
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Zip | 34119-9033
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Country | US
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Telephone | 239-591-2803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | OS18179
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License Number State | FL
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