Provider Demographics
NPI:1235120338
Name:DEVEN, ULHAS T (MD)
Entity Type:Individual
Prefix:
First Name:ULHAS
Middle Name:T
Last Name:DEVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ULHAS
Other - Middle Name:T
Other - Last Name:DEVENDRAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11707 N WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34432-5890
Mailing Address - Country:US
Mailing Address - Phone:352-465-1919
Mailing Address - Fax:352-465-7576
Practice Address - Street 1:11707 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-5890
Practice Address - Country:US
Practice Address - Phone:352-465-1919
Practice Address - Fax:352-465-7576
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0071283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2325689OtherCIGNA
FL250720000Medicaid
FL110190913OtherRAILROAD MEDICARE
FL110203293OtherRAILROAD MEDICARE
FL250720001Medicaid
FLCG8031OtherRAILROAD MEDICARE GROUP#
FL31690OtherBCBS
0118595OtherGHI
SG056481OtherVISTA
FL110203293OtherRAILROAD MEDICARE
FLCG8031OtherRAILROAD MEDICARE GROUP#
FL2325689OtherCIGNA