Provider Demographics
NPI:1962408849
Name:KULKARNI, GAJANAN A (MD)
Entity type:Individual
Prefix:DR
First Name:GAJANAN
Middle Name:A
Last Name:KULKARNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:9320 STATE ROAD 54
Practice Address - Street 2:FLORIDA CANCER SPECIALISTS P L
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1808
Practice Address - Country:US
Practice Address - Phone:727-493-2513
Practice Address - Fax:877-917-2336
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44512207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2500932OtherGHI
FL830003792OtherRR MEDICARE
9105777-001OtherCIGNA
205877OtherAVMED
FL51229OtherBC/BS FL
FL062865400Medicaid
FL5228128OtherAETNA
9105777-001OtherCIGNA
FL830003792OtherRR MEDICARE
FL51229UMedicare PIN
51229YMedicare ID - Type Unspecified