Provider Demographics
NPI:1629062393
Name:LINGAMALLU, RATNAMANI (MD)
Entity Type:Individual
Prefix:
First Name:RATNAMANI
Middle Name:
Last Name:LINGAMALLU
Suffix:
Gender:F
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 1725
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33802-1725
Mailing Address - Country:US
Mailing Address - Phone:863-683-5454
Mailing Address - Fax:863-683-4652
Practice Address - Street 1:515 E GARDEN ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4615
Practice Address - Country:US
Practice Address - Phone:863-683-5454
Practice Address - Fax:863-683-4652
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66958207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
02827OtherWELLCARE
FL375872900Medicaid
940583OtherFIRST HEALTH
202794OtherAMERIGROUP
25818OtherBCBS
1095684-005OtherCIGNA
212107OtherAVMED
FL625660OtherAETNA
591452754BOtherHUMANA
FLE62999Medicare UPIN
FL375872900Medicaid
FL625660OtherAETNA