Provider Demographics
NPI:1073837787
Name:SARUP, VIMAL (MD)
Entity type:Individual
Prefix:
First Name:VIMAL
Middle Name:
Last Name:SARUP
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 1:2001 W SAMPLE RD STE 320
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1342
Mailing Address - Country:US
Mailing Address - Phone:561-322-3588
Mailing Address - Fax:754-812-5993
Practice Address - Street 1:2001 W SAMPLE RD STE 320
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-1346
Practice Address - Country:US
Practice Address - Phone:561-322-3588
Practice Address - Fax:754-812-5993
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129277207WX0107X, 207WX0108X, 207W00000X
TXT9976207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Multi-Specialty
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease