Provider Demographics
NPI:1487083721
Name:MUNDHRA, LALITKUMAR JAYKRISHAN
Entity type:Individual
Prefix:DR
First Name:LALITKUMAR
Middle Name:JAYKRISHAN
Last Name:MUNDHRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW 34TH ST
Mailing Address - Street 2:APT Y244
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-6562
Mailing Address - Country:US
Mailing Address - Phone:407-962-6420
Mailing Address - Fax:
Practice Address - Street 1:3800 SW 34TH ST
Practice Address - Street 2:APT Y244
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-6562
Practice Address - Country:US
Practice Address - Phone:407-962-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017653500Medicaid
FLIP464ZMedicare PIN