Provider Demographics
NPI:1598707101
Name:PATTISAPU, JOGI V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOGI
Middle Name:V
Last Name:PATTISAPU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 BONNIE LOCH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2908
Mailing Address - Country:US
Mailing Address - Phone:407-730-3102
Mailing Address - Fax:407-730-3105
Practice Address - Street 1:80 BONNIE LOCH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2908
Practice Address - Country:US
Practice Address - Phone:407-730-3102
Practice Address - Fax:407-730-3105
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0058285207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063602900Medicaid
C33083Medicare UPIN
FL063602900Medicaid
FL10760WMedicare PIN
FL10760ZMedicare PIN