Provider Demographics
NPI:1609018183
Name:PRUTHI, JAGDEEP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGDEEP
Middle Name:SINGH
Last Name:PRUTHI
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 1:25103 HWY 27
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-6843
Mailing Address - Country:US
Mailing Address - Phone:863-734-0344
Mailing Address - Fax:863-439-1540
Practice Address - Street 1:25103 HWY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-6843
Practice Address - Country:US
Practice Address - Phone:863-734-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104073208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics