MEDICARE: SRAVAN K THANGEDA MD

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	207R00000X	Internal Medicine Physician	ME122293	FL
2	208M00000X	Hospitalist Physician	ME122293	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01349723	OTHER	IL	MEDICARE RAILROAD (INDIVIDUAL)
2	920540	OTHER	IL	MEDICARE PTAN (GROUP)
3	036116994	OTHER	IL	MEDICARE
4	920540040	OTHER	IL	MEDICARE PTAN (INDIVIDUAL)
5	CA4748	OTHER	IL	MEDICARE RAILROAD (GROUP)

General Provider Information

NPI Number	:	1487876439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRAVAN K THANGEDA MD

Provider Business Mailing Address
First Line	:	38135 MARKET SQ
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-7505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10991 SAN JOSE BLVD # 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-6675
Country	:	US
Telephone Number	:	904-839-1263
Fax Number	:	904-656-7306

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	02/13/2026

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Directions to “ SRAVAN K THANGEDA MD” Practice Location

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