Provider Demographics
NPI:1134179922
Name:MARATHE, SHRIRAM SHRIDHAR (MD)
Entity type:Individual
Prefix:DR
First Name:SHRIRAM
Middle Name:SHRIDHAR
Last Name:MARATHE
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 1:6445 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2954
Mailing Address - Country:US
Mailing Address - Phone:904-347-3434
Mailing Address - Fax:888-434-6275
Practice Address - Street 1:6445 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2954
Practice Address - Country:US
Practice Address - Phone:800-454-9454
Practice Address - Fax:800-454-9655
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038055207RN0300X
FLME38055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066803600Medicaid
FL55115OtherBCBS
FL066803600Medicaid
FL55115XMedicare PIN
FL55115WMedicare PIN
FLD56730Medicare UPIN
FL55115OtherBCBS