Provider Demographics
NPI:1902889413
Name:ATTANTI, SRINIVAS (MD)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:ATTANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4716
Mailing Address - Country:US
Mailing Address - Phone:352-726-8353
Mailing Address - Fax:352-726-5038
Practice Address - Street 1:910 OLD CAMP RD STE 210
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5605
Practice Address - Country:US
Practice Address - Phone:352-751-3356
Practice Address - Fax:352-751-3359
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90705207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77940OtherMEDICARE GROUP ID
FLCF1416OtherMEDICARE RR GROUP
FL11171085OtherCAQH
FL271654200Medicaid
FLME90705OtherSTATE LICENSE NUMBER
FL77940OtherBCBS OF FL GROUP ID
FLP00152441OtherMEDICARE RR
FL1410505OtherCIGNA
FL269859500OtherMEDICAID GROUP
FL48159OtherBCBS OF FL
FL269859500OtherMEDICAID GROUP
FL271654200Medicaid