Provider Demographics
NPI:1043276991
Name:KRISHNAMURTY, VELAMAKANNI (MD)
Entity Type:Individual
Prefix:
First Name:VELAMAKANNI
Middle Name:
Last Name:KRISHNAMURTY
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 1:22655 BAYSHORE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2018
Mailing Address - Country:US
Mailing Address - Phone:941-629-7092
Mailing Address - Fax:941-629-1111
Practice Address - Street 1:22655 BAYSHORE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2018
Practice Address - Country:US
Practice Address - Phone:941-629-7092
Practice Address - Fax:941-629-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44447AMedicare ID - Type Unspecified
FLG67505Medicare UPIN