Provider Demographics
NPI:1457397218
Name:BAPATLA, AMRUTH SAGAR (MD)
Entity type:Individual
Prefix:
First Name:AMRUTH
Middle Name:SAGAR
Last Name:BAPATLA
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 1:6041 SW 73RD STREET RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6464
Mailing Address - Country:US
Mailing Address - Phone:352-369-2040
Mailing Address - Fax:352-369-2045
Practice Address - Street 1:6041 SW 73RD STREET RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6464
Practice Address - Country:US
Practice Address - Phone:352-369-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069028174400000X
FLME69028174400000X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378791500Medicaid
FL27838AMedicare ID - Type Unspecified
FLF51843Medicare UPIN