MEDICARE: KIRAN K. SANDRAPATY 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
1	208100000X	Physical Medicine & Rehabilitation Physician	29291	SC

General Provider Information

NPI Number	:	1407865330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRAN K. SANDRAPATY MD

Provider Business Mailing Address
First Line	:	3106 DEVINE ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1846
Country	:	US
Telephone Number	:	803-252-2255
Fax Number	:	803-252-5436

Provider Business Practice Location Address
First Line	:	3106 DEVINE ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1846
Country	:	US
Telephone Number	:	803-252-2255
Fax Number	:	803-252-5436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/29/2011

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