Provider Demographics
NPI:1356596696
Name:LAKHANI, MAYUR JIVRAJBHAI (MD)
Entity type:Individual
Prefix:
First Name:MAYUR
Middle Name:JIVRAJBHAI
Last Name:LAKHANI
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 1:3028 CARING WAY UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5300
Mailing Address - Country:US
Mailing Address - Phone:941-212-2748
Mailing Address - Fax:941-328-8946
Practice Address - Street 1:3028 CARING WAY UNIT 4
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5300
Practice Address - Country:US
Practice Address - Phone:941-212-2748
Practice Address - Fax:941-328-8946
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-01748207R00000X, 207RI0011X
NY255995207RI0011X
FLME138892207R00000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03860280Medicaid
NYJ400136320Medicare PIN