Provider Demographics
NPI:1447211545
Name:JADHAV, AVINASH LAXMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AVINASH
Middle Name:LAXMAN
Last Name:JADHAV
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 333
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34460-0333
Mailing Address - Country:US
Mailing Address - Phone:352-565-5999
Mailing Address - Fax:352-565-4449
Practice Address - Street 1:17222 HOSPITAL BLVD STE 322
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:352-565-5999
Practice Address - Fax:352-565-4449
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137486207X00000X
MI4301091180207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360359Medicare PIN
MIM96990019Medicare PIN
FLH72422Medicare UPIN