Provider Demographics
NPI:1104826999
Name:BAVETTA, LUDWIG (MD)
Entity Type:Individual
Prefix:DR
First Name:LUDWIG
Middle Name:
Last Name:BAVETTA
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:PO BOX 895124
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34789-5124
Mailing Address - Country:US
Mailing Address - Phone:352-552-4273
Mailing Address - Fax:352-728-0083
Practice Address - Street 1:502 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4720
Practice Address - Country:US
Practice Address - Phone:352-726-1551
Practice Address - Fax:352-726-9119
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49346207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046108300Medicaid
FL1104826999OtherINDIVIDUAL NPI
FLD20872Medicare UPIN
FL04073Medicare ID - Type Unspecified