Healthcare Provider Details

I. General information

NPI: 1134156458
Provider Name (Legal Business Name): UMESH LINGE GOWDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 EICHENFELD DR
BRANDON FL
33511-5908
US

IV. Provider business mailing address

635 EICHENFELD DR
BRANDON FL
33511-5908
US

V. Phone/Fax

Practice location:
  • Phone: 813-684-6000
  • Fax: 813-654-9032
Mailing address:
  • Phone: 813-684-6000
  • Fax: 813-685-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME73681
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME73681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: