Provider Demographics
NPI:1811943376
Name:RAGHUVEERA, ANAVATTI L (MD)
Entity type:Individual
Prefix:DR
First Name:ANAVATTI
Middle Name:L
Last Name:RAGHUVEERA
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 1:77 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9571
Mailing Address - Country:US
Mailing Address - Phone:863-699-5437
Mailing Address - Fax:863-699-9000
Practice Address - Street 1:77 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9571
Practice Address - Country:US
Practice Address - Phone:863-699-5437
Practice Address - Fax:863-699-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83514208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265563200Medicaid
FL47857OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLG42515Medicare UPIN