Provider Demographics
NPI:1386671303
Name:KINI, NARENDRA M (MD)
Entity type:Individual
Prefix:
First Name:NARENDRA
Middle Name:M
Last Name:KINI
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 1:12850 SW 60TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12850 SW 60TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-7101
Practice Address - Country:US
Practice Address - Phone:305-661-6072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI084506207PE0004X
FLME106315208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINK084506OtherBLUE SHIELD
MI104654307Medicaid
MINK084506OtherBLUE SHIELD