Active NPI
Gautami Satish Dholakia, MD
- Pediatrics Physician
- Lakeland, FL
National Provider Identifier
1619049863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME98715
- Practice address
- 2515 Troy Ave
Lakeland, FL 33803-2960 - Phone
- (863) 686-7189
- Fax
- (863) 687-4268
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME98715 | FL | Primary |
Addresses
Primary practice location
2515 Troy Ave
Lakeland, FL 33803-2960
Mailing address
PO Box 152557
Tampa, FL 33684-2557
Phone (863) 686-7189
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052602908 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME98715 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1619049863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 152557",
"city": "TAMPA",
"state": "FL",
"postal_code": "336842557",
"telephone_number": "863-686-7189",
"fax_number": "863-687-4268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2515 TROY AVE",
"city": "LAKELAND",
"state": "FL",
"postal_code": "338032960",
"telephone_number": "863-686-7189",
"fax_number": "863-687-4268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DHOLAKIA",
"first_name": "GAUTAMI",
"middle_name": "SATISH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-14",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME98715",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "052602908",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.