Provider Demographics
NPI:1356314496
Name:GHEEWALA, URJIT DEEPAK (MD)
Entity Type:Individual
Prefix:
First Name:URJIT
Middle Name:DEEPAK
Last Name:GHEEWALA
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 1:9165 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-5406
Mailing Address - Country:US
Mailing Address - Phone:727-578-7618
Mailing Address - Fax:727-578-7619
Practice Address - Street 1:9165 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-5406
Practice Address - Country:US
Practice Address - Phone:727-578-7618
Practice Address - Fax:727-578-7619
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263752900Medicaid
FLE7323YMedicare PIN
FL263752900Medicaid