Provider Demographics
NPI:1265445654
Name:GULATI, ANKUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANKUSH
Middle Name:
Last Name:GULATI
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 1:3227 LEE BLVD
Mailing Address - Street 2:UNIT 4
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1428
Mailing Address - Country:US
Mailing Address - Phone:239-303-2820
Mailing Address - Fax:239-303-2511
Practice Address - Street 1:3227 LEE BLVD
Practice Address - Street 2:UNIT 4
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1428
Practice Address - Country:US
Practice Address - Phone:239-303-2820
Practice Address - Fax:239-303-2511
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85821207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47840OtherBCBSFL
FLE8275YMedicare PIN
FL47840OtherBCBSFL