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NPI Code Detail

MEDICARE: KANTHI DHADUVAI MD

MEDICARE: KANTHI DHADUVAI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician141369FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245613942
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANTHI DHADUVAI MD
Provider Business Mailing Address
First Line : 3000 SPRING PARK RD UNIT 10642
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32247-8566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5978 POWERS AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32217-2210
Country : US
Telephone Number : 904-399-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2015
Last Update Date : 01/29/2022

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