Provider Demographics
NPI:1093799298
Name:KIDAMBI, VASUDEVAN ANJORE (MD)
Entity Type:Individual
Prefix:DR
First Name:VASUDEVAN
Middle Name:ANJORE
Last Name:KIDAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 SW 34TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7456
Mailing Address - Country:US
Mailing Address - Phone:352-732-2900
Mailing Address - Fax:352-732-4430
Practice Address - Street 1:3200 SW 34TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7456
Practice Address - Country:US
Practice Address - Phone:352-732-2900
Practice Address - Fax:352-732-4430
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379283800Medicaid
FLG14198Medicare UPIN
FL379283800Medicaid