Healthcare Provider Details

I. General information

NPI: 1669402459
Provider Name (Legal Business Name): LOKESH V VATTIGUNTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 TALAVERA PLACE
PALM BEACH GARDENS FL
33418-6221
US

IV. Provider business mailing address

119 TALAVERA PLACE
PALM BEACH GARDENS FL
33418-6221
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-1004
  • Fax: 561-616-6408
Mailing address:
  • Phone: 561-433-1004
  • Fax: 561-616-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: