MEDICARE: DR. RAVIKANTH VYDYULA MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME124733	FL
2	207RP1001X	Pulmonary Disease Physician	ME124733	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01618009	OTHER	FL	RR MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942443551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVIKANTH VYDYULA MD

Provider Business Mailing Address
First Line	:	13067 N TELECOM PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33637-0926
Country	:	US
Telephone Number	:	813-779-6303
Fax Number	:	786-868-0012

Provider Business Practice Location Address
First Line	:	2700 HEALING WAY STE 112
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-5453
Country	:	US
Telephone Number	:	813-929-5226
Fax Number	:	813-929-5223

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	03/18/2024

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