Provider Demographics
NPI:1013944370
Name:KETHEESWARAN, BHAVANI (MD)
Entity Type:Individual
Prefix:
First Name:BHAVANI
Middle Name:
Last Name:KETHEESWARAN
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 1:2810 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0446
Mailing Address - Country:US
Mailing Address - Phone:352-732-0122
Mailing Address - Fax:
Practice Address - Street 1:2810 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0446
Practice Address - Country:US
Practice Address - Phone:352-732-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82362207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13015OtherBCBS
FL262712400Medicaid
FL262712400Medicaid
FLH54562Medicare UPIN