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General NPI Number Information
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NPI Number | 1174919872
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Entity Type | Individual
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Provider Name | VINAY BHAMIDIPATI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 4900 W OAKLAND PARK BLVD STE 105
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1555
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Country | US
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Telephone | 954-945-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 215 SE 8TH AVE APT 720
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-3885
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Country | US
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Telephone | 609-457-1076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 277330
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME139011
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License Number State | FL
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