MEDICARE: PRATIMA DESHMUKH 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	207R00000X	Internal Medicine Physician	ME103241	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	EN433Y	OTHER	FL	MEDICARE

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	:	1932109782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATIMA DESHMUKH M.D.

Provider Business Mailing Address
First Line	:	515 W STATE ROAD 434 STE 110
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5161
Country	:	US
Telephone Number	:	407-830-8600
Fax Number	:	407-830-5110

Provider Business Practice Location Address
First Line	:	515 W STATE ROAD 434
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4981
Country	:	US
Telephone Number	:	407-830-8600
Fax Number	:	407-830-5110

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/13/2021

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Directions to “ PRATIMA DESHMUKH M.D.” Practice Location

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