Provider Demographics
NPI:1528035730
Name:MAKKENA, RAMARAO (MD)
Entity type:Individual
Prefix:
First Name:RAMARAO
Middle Name:
Last Name:MAKKENA
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 1:3389 W VINE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4665
Mailing Address - Country:US
Mailing Address - Phone:407-932-2799
Mailing Address - Fax:407-932-0303
Practice Address - Street 1:3389 W VINE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4665
Practice Address - Country:US
Practice Address - Phone:407-932-2799
Practice Address - Fax:407-932-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME935202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38008OtherBCBS
FL38008OtherBCBS
FLU6809Medicare PIN