MEDICARE: DR. LEELA S LAVASANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	MT188403	PA
2	207Y00000X	Otolaryngology Physician	ME109866	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083810493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEELA S LAVASANI M.D.

Provider Business Mailing Address
First Line	:	6376 PINE RIDGE RD UNIT 450
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3928
Country	:	US
Telephone Number	:	239-514-2225
Fax Number	:	239-514-2280

Provider Business Practice Location Address
First Line	:	6376 PINE RIDGE RD UNIT 450
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3928
Country	:	US
Telephone Number	:	239-514-2225
Fax Number	:	239-514-2280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	06/01/2022

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