Provider Demographics
NPI:1134117120
Name:AKULA, MALATHI LATHA (MD)
Entity Type:Individual
Prefix:
First Name:MALATHI
Middle Name:LATHA
Last Name:AKULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4202
Mailing Address - Country:US
Mailing Address - Phone:407-343-2700
Mailing Address - Fax:407-343-4807
Practice Address - Street 1:591 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4202
Practice Address - Country:US
Practice Address - Phone:407-343-2700
Practice Address - Fax:407-343-4807
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273043000Medicaid
FL273043000Medicaid
FL28174WMedicare PIN