Basic Information
| Provider Information | |||||||||
| NPI: | 1346489937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAKE | ||||||||
| FirstName: | VYAS | ||||||||
| MiddleName: | NARESH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 8727 TEMPLE TERRACE HWY | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336376700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137965400 | ||||||||
| FaxNumber: | 8137760079 | ||||||||
| Practice Location | |||||||||
| Address1: | 8727 TEMPLE TERRACE HWY | ||||||||
| Address2: | |||||||||
| City: | TEMPLE TERRACE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336376700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137965400 | ||||||||
| FaxNumber: | 8137760079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2009 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10031137 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2011-0207 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME152591 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | Z2565 | 01 | NM | MEDICAID GROUP | OTHER | 1932187044 | 01 | NM | GROUP NPI | OTHER | 85001732 | 05 | NM | MEDICAID | 800521089 | 01 | NM | MEDICARE GROUP ID | OTHER |