Healthcare Provider Details

I. General information

NPI: 1154638682
Provider Name (Legal Business Name): LIKHITESH GUNJUR JAIKUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST STE 400
SARASOTA FL
34239-3513
US

IV. Provider business mailing address

1950 ARLINGTON ST STE 400
SARASOTA FL
34239-3513
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-4250
  • Fax:
Mailing address:
  • Phone: 941-917-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125056500
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28185
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28185
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME168352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: