Provider Demographics
NPI:1164482410
Name:KURAKULA, SATYA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SATYA
Middle Name:S
Last Name:KURAKULA
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 1:5802 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-1469
Mailing Address - Country:US
Mailing Address - Phone:813-236-5300
Mailing Address - Fax:813-237-5402
Practice Address - Street 1:5802 N 30TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1469
Practice Address - Country:US
Practice Address - Phone:813-236-5300
Practice Address - Fax:813-237-5402
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21781207Q00000X
FLME104552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT60458Medicaid
FL004511800Medicaid
FLFV969ZMedicare PIN
SCH20200Medicare UPIN
FL004511800Medicaid