MEDICARE: DR. RATNAMANI LINGAMALLU 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	174400000X	Specialist	ME66958	FL
2	207K00000X	Allergy & Immunology Physician	ME66958	FL
3	207Y00000X	Otolaryngology Physician	ME66958	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	212107	OTHER		AVMED
2	940583	OTHER		FIRST HEALTH
3	202794	OTHER		AMERIGROUP
4	591452754B	OTHER		HUMANA
5	625660	OTHER	FL	AETNA
6	02827	OTHER		WELLCARE
7	25818	OTHER		BCBS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	1095684-005	OTHER		CIGNA

General Provider Information

NPI Number	:	1629062393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RATNAMANI LINGAMALLU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 878
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33836-0878
Country	:	US
Telephone Number	:	689-223-3898
Fax Number	:	689-223-3898

Provider Business Practice Location Address
First Line	:	515 E GARDEN ST
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4615
Country	:	US
Telephone Number	:	863-683-5454
Fax Number	:	863-683-4652

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	03/24/2025

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