Provider Demographics
NPI:1427152610
Name:KARKAL, SHIVANAND S (MD)
Entity type:Individual
Prefix:
First Name:SHIVANAND
Middle Name:S
Last Name:KARKAL
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 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835
Mailing Address - Country:US
Mailing Address - Phone:407-644-5544
Mailing Address - Fax:407-294-0445
Practice Address - Street 1:1507 S HIAWASSEE RD STE 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5706
Practice Address - Country:US
Practice Address - Phone:407-644-5544
Practice Address - Fax:407-294-0445
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066221207RC0000X
FLME66221207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376946100Medicaid
FL25646CMedicare ID - Type Unspecified