Provider Demographics
NPI:1104480854
Name:TIRUMALASETTY, KIRAN
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:TIRUMALASETTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 STATE ROAD 54 STE 202
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1810
Mailing Address - Country:US
Mailing Address - Phone:727-597-4441
Mailing Address - Fax:727-597-4445
Practice Address - Street 1:9332 STATE ROAD 54 STE 202
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1810
Practice Address - Country:US
Practice Address - Phone:727-597-4441
Practice Address - Fax:727-597-4445
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine