=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144819533
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINOTH MUTHALAGAPPAN DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2021
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16621 LAGOON SHORE BLVD
-----------------------------------------------------
City | WIMAUMA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33598-4177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-653-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16621 LAGOON SHORE BLVD
-----------------------------------------------------
City | WIMAUMA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33598-4177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-653-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO4234
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 328578
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------