Provider Demographics
NPI:1043300486
Name:THIMMARAYAPPA, MAHESHA (MD)
Entity Type:Individual
Prefix:
First Name:MAHESHA
Middle Name:
Last Name:THIMMARAYAPPA
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 1:1855 VETERANS PARK DR STE 304
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0446
Mailing Address - Country:US
Mailing Address - Phone:239-676-0656
Mailing Address - Fax:239-533-9735
Practice Address - Street 1:1855 VETERANS PARK DR STE 304
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0446
Practice Address - Country:US
Practice Address - Phone:239-676-0656
Practice Address - Fax:239-533-9735
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME138498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403355800Medicaid
MDH578Medicare PIN
MD403355800Medicaid