MEDICARE: DR. NANDINI KIRI MD PA

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	207R00000X	Internal Medicine Physician	ME82594	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
2	05106	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1588658819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANDINI KIRI MD PA

Provider Business Mailing Address
First Line	:	4315 HIGHLAND PARK BLVD STE A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1639
Country	:	US
Telephone Number	:	863-816-5884
Fax Number	:	863-940-4856

Provider Business Practice Location Address
First Line	:	4315 HIGHLAND PARK BLVD STE A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1639
Country	:	US
Telephone Number	:	863-816-5884
Fax Number	:	863-940-4856

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	12/20/2025

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