=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679811459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUNI V. PADMAN, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2013
-----------------------------------------------------
Last Update Date | 01/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 E DIXIE AVE PLAZA 101
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-5953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-326-8081
-----------------------------------------------------
Fax | 352-326-5084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 E DIXIE AVE PLAZA 101
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-5953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-326-8081
-----------------------------------------------------
Fax | 352-326-5084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MUNI V PADMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 352-326-8081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | ME35184
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------