Provider Demographics
NPI:1154358109
Name:AKULA, GANESH K (MD)
Entity type:Individual
Prefix:DR
First Name:GANESH
Middle Name:K
Last Name:AKULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1203
Mailing Address - Country:US
Mailing Address - Phone:407-425-3362
Mailing Address - Fax:407-425-8824
Practice Address - Street 1:930 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1203
Practice Address - Country:US
Practice Address - Phone:407-425-3362
Practice Address - Fax:407-425-8824
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60461207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0575950500Medicaid
FL14528Medicare ID - Type Unspecified
FL0575950500Medicaid