Basic Information
| Provider Information | |||||||||
| NPI: | 1487876439 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THANGEDA | ||||||||
| FirstName: | SRAVAN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38135 MARKET SQ | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335427505 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 38135 MARKET SQ | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137802155 | ||||||||
| FaxNumber: | 8133555017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME122293 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME122293 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 036116994 | 01 | IL | MEDICARE | OTHER | 920540 | 01 | IL | MEDICARE PTAN (GROUP) | OTHER | 920540040 | 01 | IL | MEDICARE PTAN (INDIVIDUAL) | OTHER | CA4748 | 01 | IL | MEDICARE RAILROAD (GROUP) | OTHER | P01349723 | 01 | IL | MEDICARE RAILROAD (INDIVIDUAL) | OTHER |