Provider Demographics
NPI:1699746891
Name:MENDIRATTA, VIPIN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:VIPIN
Middle Name:KUMAR
Last Name:MENDIRATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:861 OAKLEY SEAVER DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:352-394-7125
Mailing Address - Fax:352-394-2584
Practice Address - Street 1:861 OAKLEY SEAVER DR UNIT A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-394-7125
Practice Address - Fax:352-394-2584
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME88156208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268517500Medicaid
FL268517500Medicaid