Ted F Kadivar, MD PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME0068030 Issued in FL

Practice address

250 2ND St E
Suite 4C
Bradenton, FL 34208-1029

Phone

(941) 744-5860

Fax

(941) 744-5681

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484784000000",
    "number": "1508898255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 2ND ST E",
            "address_2": "SUITE 4C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081029",
            "telephone_number": "941-744-5860",
            "fax_number": "941-744-5681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 2ND ST E",
            "address_2": "SUITE 4C",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081029",
            "telephone_number": "941-744-5860",
            "fax_number": "941-744-5681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KADIVAR",
        "first_name": "TED",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "credential": "MD PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2017-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME0068030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "593650291",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377823100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "27168",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lisa M Kaczmarek, LCSW
• Ian M. Kahane, M.D.
• Dana Renee Kahl, LCSW
• Sreelatha Kakarala, M.D.
• Axay S Kalathia, M.D.
• Marc Stephen Kallins, MD

• Surgery Physician in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.