Provider Demographics
NPI:1295788180
Name:UMAMAHESWARAN, INDIRA (MD)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:UMAMAHESWARAN
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 1:7539 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6502
Mailing Address - Country:US
Mailing Address - Phone:727-869-2115
Mailing Address - Fax:727-863-6167
Practice Address - Street 1:7539 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6502
Practice Address - Country:US
Practice Address - Phone:727-869-2115
Practice Address - Fax:727-863-6167
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME920562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275138100Medicaid
FL42042OtherBLUE CROSS BLUE SHIELD
FL275138100Medicaid
FL42042YMedicare PIN