Provider Demographics
NPI:1366463390
Name:BABUGOWDA, LALANA (MD)
Entity type:Individual
Prefix:DR
First Name:LALANA
Middle Name:
Last Name:BABUGOWDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 ALT 19 STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5357
Mailing Address - Country:US
Mailing Address - Phone:727-942-8900
Mailing Address - Fax:727-942-8989
Practice Address - Street 1:2122 ALT 19 STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5357
Practice Address - Country:US
Practice Address - Phone:727-942-8900
Practice Address - Fax:727-942-8989
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094165207Q00000X
FLME109779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL350135OtherAVMED
FLP01150061OtherRAILROAD MEDICARE
FL004456100Medicaid
FL004456100Medicaid
IL080173505OtherMEDICARE RAILROAD
IL036094165Medicaid
FL350135OtherAVMED
IL833120OtherMEDICARE GROUP PTAN
ILIL01N6OtherJOHN DEERE
IL069207OtherHEALTH ALLIANCE
IL472312OtherHEALTHLINK
CA2264OtherRR MEDICARE - GROUP #
ILG56474Medicare UPIN
IL7215059OtherBCBS PPO