Provider Demographics
NPI:1275769655
Name:ADUSUMALLI, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:KUMAR
Last Name:ADUSUMALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3964
Mailing Address - Country:US
Mailing Address - Phone:703-483-1607
Mailing Address - Fax:937-222-2233
Practice Address - Street 1:700 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3964
Practice Address - Country:US
Practice Address - Phone:703-483-1607
Practice Address - Fax:937-222-2233
Is Sole Proprietor?:No
Enumeration Date:2009-05-31
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093464207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology