Provider Demographics
NPI:1053731885
Name:BOELKE, VINDYA (MD)
Entity type:Individual
Prefix:
First Name:VINDYA
Middle Name:
Last Name:BOELKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VINDYA
Other - Middle Name:
Other - Last Name:GUNAWARDENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD.
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7708
Mailing Address - Fax:863-680-7641
Practice Address - Street 1:1600 LAKELAND HILLS BLVD.
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3019
Practice Address - Country:US
Practice Address - Phone:863-680-7190
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129778207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism