Provider Demographics
NPI:1114156569
Name:KALYANI GADDIPATI MD PL
Entity Type:Organization
Organization Name:KALYANI GADDIPATI MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:KALYANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-936-2444
Mailing Address - Street 1:917 RINEHART RD
Mailing Address - Street 2:SUITE 2051
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4802
Mailing Address - Country:US
Mailing Address - Phone:407-936-2444
Mailing Address - Fax:407-936-2448
Practice Address - Street 1:917 RINEHART RD
Practice Address - Street 2:SUITE 2051
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4802
Practice Address - Country:US
Practice Address - Phone:407-936-2444
Practice Address - Fax:407-936-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty