Provider Demographics
NPI:1023010808
Name:TALLURI, GIRIDHAR S (MD)
Entity Type:Individual
Prefix:
First Name:GIRIDHAR
Middle Name:S
Last Name:TALLURI
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 1:21110 BISCAYNE BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1252
Mailing Address - Country:US
Mailing Address - Phone:305-918-0742
Mailing Address - Fax:305-918-0787
Practice Address - Street 1:21110 BISCAYNE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1252
Practice Address - Country:US
Practice Address - Phone:305-918-0742
Practice Address - Fax:305-918-0787
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85266208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34506OtherBCBS
FL43118OtherNHP
FL7746438OtherAETNA
FLH65077OtherVISTA
FL007325500Medicaid
FL288172OtherAVMED
FL190236OtherAMERIGROUP
FL3980742OtherCIGNA
FLP00301349OtherRAILROAD MEDICARE
FL51423YMedicare PIN
FL7746438OtherAETNA