Provider Demographics
NPI:1225058662
Name:SRIRAM, PERUVEMBA SUNDARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PERUVEMBA
Middle Name:SUNDARAM
Last Name:SRIRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PERUVEMBA
Other - Middle Name:
Other - Last Name:SRIRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-846-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMFC1555207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44625ZMedicare PIN
H86861Medicare UPIN
FL44625Medicare ID - Type Unspecified