Provider Demographics
NPI:1538189915
Name:THENAPPAN, ARUNACHALAM (MD)
Entity type:Individual
Prefix:DR
First Name:ARUNACHALAM
Middle Name:
Last Name:THENAPPAN
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 1:3450 LANTANA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1329
Mailing Address - Country:US
Mailing Address - Phone:561-965-1864
Mailing Address - Fax:561-967-5005
Practice Address - Street 1:3450 LANTANA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1329
Practice Address - Country:US
Practice Address - Phone:561-965-1864
Practice Address - Fax:561-967-5005
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068510207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378918700Medicaid
830002741OtherRAILROAD MEDICARE
FL378918700Medicaid
FL27133ZMedicare ID - Type Unspecified