Organization
POLK WELLCARE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HIMAGIRI RAVI MD (OWNER)
(863) 293-3909
Entity
Organization
Contact information
Practice address
2017 WINDWOOD LN, LAKELAND, FL 33813-4807
(863) 293-3909
(863) 293-1909
Mailing address
1045 E COUNTY ROAD 540A, LAKELAND, FL 33813-3735
(863) 293-3909
(863) 293-1909
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0045684
FL
Other
Enumeration date
11/02/2006
Last updated
08/22/2020
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