Provider Demographics
NPI:1891154498
Name:FLORIDA UROLOGY PARTNERS, LLP
Entity Type:Organization
Organization Name:FLORIDA UROLOGY PARTNERS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
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:813-258-9565
Mailing Address - Street 1:1 DAVIS BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3480
Mailing Address - Country:US
Mailing Address - Phone:813-258-9565
Mailing Address - Fax:813-258-3535
Practice Address - Street 1:1 DAVIS BLVD STE 604
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3480
Practice Address - Country:US
Practice Address - Phone:813-258-9565
Practice Address - Fax:813-258-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
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 UPIN