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1538154547

NPI Code Detail

MEDICARE: VIDYA P KINI MD

MEDICARE: VIDYA P KINI 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	ME56122	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1538154547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIDYA P KINI MD

Provider Business Mailing Address
First Line	:	1565 MATTHEW DR 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1734
Country	:	US
Telephone Number	:	239-274-5464
Fax Number	:	239-275-5464

Provider Business Practice Location Address
First Line	:	3033 WINKLER AVE UNIT 100
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-9523
Country	:	US
Telephone Number	:	239-277-7070
Fax Number	:	239-277-7071

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	05/22/2023

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Directions to “ VIDYA P KINI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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