Provider Demographics
NPI:1558811315
Name:FLORIDA UROLOGY PARTNERS LLP
Entity Type:Organization
Organization Name:FLORIDA UROLOGY PARTNERS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVIENDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKKAPATNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-850-0026
Mailing Address - Street 1:3140 S FALKENBURG RD
Mailing Address - Street 2:STE 203
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2574
Mailing Address - Country:US
Mailing Address - Phone:813-850-0026
Mailing Address - Fax:813-620-9181
Practice Address - Street 1:3140 S FALKENBURG RD
Practice Address - Street 2:STE 203
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2574
Practice Address - Country:US
Practice Address - Phone:813-850-0026
Practice Address - Fax:813-620-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90062332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47380ZMedicare PIN