Provider Demographics
NPI:1699765578
Name:BHAMIDIPATI, LALITA NMN (MD)
Entity type:Individual
Prefix:DR
First Name:LALITA
Middle Name:NMN
Last Name:BHAMIDIPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 405
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-3500
Practice Address - Fax:941-917-3501
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03225OtherBCBS
FL264826100Medicaid
FL03225ZMedicare PIN
FL264826100Medicaid