Individual
GAUTHAM MOGILISHETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3400 LEE BLVD STE 112, LEHIGH ACRES, FL 33971-1309
(239) 939-0999
(239) 939-1070
Mailing address
3400 LEE BLVD STE 112, LEHIGH ACRES, FL 33971-1309
(239) 939-0999
(239) 939-1070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35-084821
OH
207RN0300X
Nephrology Physician
35-084821
OH
207RN0300X
Nephrology Physician
Primary
ME129188
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200207710
—
IN
05
—
2521542
—
OH
05
—
64091192
—
KY
Enumeration date
04/27/2006
Last updated
11/11/2022
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