Individual
GAUTAMI SATISH DHOLAKIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2515 TROY AVE, LAKELAND, FL 33803-2960
(863) 686-7189
(863) 687-4268
Mailing address
PO BOX 152557, TAMPA, FL 33684-2557
(863) 686-7189
(863) 687-4268
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME98715
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
052602908
—
FL
Enumeration date
11/14/2006
Last updated
06/19/2012
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