MEDICARE: VIJAYALAKSHMI POLAVARAPU 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	207Q00000X	Family Medicine Physician	ME91019	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

General Provider Information

NPI Number	:	1790766756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAYALAKSHMI POLAVARAPU M.D.

Provider Business Mailing Address
First Line	:	PO BOX 616788
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32861-6788
Country	:	US
Telephone Number	:	407-447-7105
Fax Number	:	407-770-0594

Provider Business Practice Location Address
First Line	:	6350 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7823
Country	:	US
Telephone Number	:	407-281-1755
Fax Number	:	407-282-6871

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	03/07/2023

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