Individual
DR. GNANESWARA V MIDATHALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3130 SW 27TH AVE, OCALA, FL 34471-4306
(352) 547-2097
Mailing address
PO BOX 100183, GAINESVILLE, FL 32610-0183
(352) 392-0140
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036092506
IL
2084P0800X
Psychiatry Physician
86855
SC
2084P0800X
Psychiatry Physician
Primary
ME109325
FL
Other
Enumeration date
08/12/2006
Last updated
11/02/2021
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