MEDICARE: DR. INDI VASUDEVA 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	ME93153	FL
2	207RN0300X	Nephrology Physician	ME93153	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME93153	OTHER	FL	FLORIDA MEDICAL LICENSE

General Provider Information

NPI Number	:	1629074596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INDI VASUDEVA M.D.

Provider Business Mailing Address
First Line	:	4218 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-269-7555
Fax Number	:	813-269-7575

Provider Business Practice Location Address
First Line	:	4218 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5241
Country	:	US
Telephone Number	:	813-961-6633
Fax Number	:	813-961-7733

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	10/16/2025

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