1235120338 NPI number — ULHAS T DEVEN M.D.

Table of content: ULHAS T DEVEN M.D. (NPI 1235120338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235120338 NPI number — ULHAS T DEVEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVEN
Provider First Name:
ULHAS
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEVENDRAPPA
Provider Other First Name:
ULHAS
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235120338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11707 N WILLIAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNNELLON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34432-5890
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-465-1919
Provider Business Mailing Address Fax Number:
352-465-7576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11707 N WILLIAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNNELLON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34432-5890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-465-1919
Provider Business Practice Location Address Fax Number:
352-465-7576
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME 0071283 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2325689 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 250720000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110190913 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110203293 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 250720001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG8031 . This is a "RAILROAD MEDICARE GROUP#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 31690 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0118595 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: SG056481 . This is a "VISTA" identifier . This identifiers is of the category "OTHER".




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