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General NPI Number Information
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NPI Number | 1619049863
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Entity Type | Individual
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Provider Name | GAUTAMI SATISH DHOLAKIA MD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 2515 TROY AVE
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City | LAKELAND
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State | FL
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Zip | 33803-2960
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Country | US
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Telephone | 863-686-7189
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Fax | 863-687-4268
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Provider Business Mailing Address
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Address Line | PO BOX 152557
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City | TAMPA
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State | FL
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Zip | 33684-2557
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Country | US
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Telephone | 863-686-7189
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Fax | 863-687-4268
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME98715
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License Number State | FL
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