Healthcare Provider Details

I. General information

NPI: 1730677089
Provider Name (Legal Business Name): RIPUDAMAN JOSHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKELAND HILLS BLVD
LAKELAND FL
33805-4543
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD STE A
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1100
  • Fax:
Mailing address:
  • Phone: 863-816-5884
  • Fax: 863-940-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME151018
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11854200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: