Provider Demographics
NPI:1124060587
Name:RAMAKRISHNA P KANURI M.D.P.A.
Entity type:Organization
Organization Name:RAMAKRISHNA P KANURI M.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KANURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-1208
Mailing Address - Street 1:12190 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5578
Mailing Address - Country:US
Mailing Address - Phone:352-597-1206
Mailing Address - Fax:352-597-1208
Practice Address - Street 1:12190 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5578
Practice Address - Country:US
Practice Address - Phone:352-597-1206
Practice Address - Fax:352-597-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45467OtherBCBS GRP #
FLK1981Medicare ID - Type UnspecifiedMCR GRP #