MEDICARE: MONALI LAXPATI GIDWANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME111199	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053348052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONALI LAXPATI GIDWANI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 734951
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-4951
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	1330 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1838
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	06/30/2026

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