Provider Demographics
NPI:1437285178
Name:RAMESH, CHEMBU VIDYASAGAR (MD)
Entity Type:Individual
Prefix:
First Name:CHEMBU
Middle Name:VIDYASAGAR
Last Name:RAMESH
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 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-594-5554
Mailing Address - Fax:352-265-0379
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-594-5554
Practice Address - Fax:352-265-0379
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47292207R00000X
FLME110097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34572700Medicaid
FL003772400Medicaid
FLFF915ZMedicare PIN