Provider Demographics
NPI:1366403867
Name:MEDIRATTA, SUNDEEP (MD)
Entity type:Individual
Prefix:
First Name:SUNDEEP
Middle Name:
Last Name:MEDIRATTA
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 1:1723 LUCERNE TER STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2916
Mailing Address - Country:US
Mailing Address - Phone:407-738-4200
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:805 OAKLEY SEAVER DR STE A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1968
Practice Address - Country:US
Practice Address - Phone:407-738-4200
Practice Address - Fax:407-705-2540
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85297207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265507100Medicaid
FLME85297OtherMEDICAL LICENSE
FLME85297OtherMEDICAL LICENSE
FL47970TMedicare PIN
G55382Medicare UPIN
FL47970XMedicare PIN
FL47970Medicare PIN