Individual
UMESH MADHAV MHATRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
165 SW VISION GLENN, LAKE CITY, FL 32025-1111
(386) 755-1800
(386) 758-8770
Mailing address
165 SW VISION GLENN, LAKE CITY, FL 32025-1111
(386) 755-1800
(386) 758-8770
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME-0027561
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01251
BC/BS OF FL
FL
05
—
037553500
—
FL
01
—
406263894
RAIILROAD MEDICARE
FL
01
—
592245265 2001
OHIO BUREAU WORK COMP
FL
01
—
ME0027561
FL LICENSE
FL
Enumeration date
10/17/2006
Last updated
07/09/2007
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