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General NPI Number Information
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NPI Number | 1063404028
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Entity Type | Individual
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Provider Name | PANDURANGAN NMI KRISHNARAJ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 37840 MEDICAL ARTS CT
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-4325
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Country | US
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Telephone | 813-788-5569
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Fax | 813-782-8628
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Provider Business Mailing Address
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Address Line | 37840 MEDICAL ARTS CT
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-4325
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Country | US
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Telephone | 813-788-5569
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Fax | 813-782-8628
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME52220
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License Number State | FL
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