Healthcare Provider Details

I. General information

NPI: 1497054100
Provider Name (Legal Business Name): RAVI SHARAD LAKDAWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12662 TELECOM DR
TEMPLE TERRACE FL
33637-0935
US

IV. Provider business mailing address

12662 TELECOM DR
TEMPLE TERRACE FL
33637-0935
US

V. Phone/Fax

Practice location:
  • Phone: 813-910-0030
  • Fax: 813-971-6473
Mailing address:
  • Phone: 813-910-0030
  • Fax: 813-971-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME177591
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME177591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: