Healthcare Provider Details

I. General information

NPI: 1053348052
Provider Name (Legal Business Name): MONALI LAXPATI GIDWANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONALI JATIN LAXPATI M.D.

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S ANDREWS AVE
FT LAUDERDALE FL
33316-1838
US

IV. Provider business mailing address

PO BOX 734951
CHICAGO IL
60673-4951
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME111199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: