Provider Demographics
NPI:1144819533
Name:MUTHALAGAPPAN, VINOTH (DPM)
Entity type:Individual
Prefix:DR
First Name:VINOTH
Middle Name:
Last Name:MUTHALAGAPPAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16621 LAGOON SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4177
Mailing Address - Country:US
Mailing Address - Phone:813-653-6100
Mailing Address - Fax:
Practice Address - Street 1:16621 LAGOON SHORE BLVD
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4177
Practice Address - Country:US
Practice Address - Phone:813-653-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4234213E00000X
LA328578213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist