Provider Demographics
NPI:1285814541
Name:MADDIPATI, MURALI KRISHNA (MD,)
Entity Type:Individual
Prefix:DR
First Name:MURALI KRISHNA
Middle Name:
Last Name:MADDIPATI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:MURALI
Other - Middle Name:
Other - Last Name:KRISHNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2946 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3140
Mailing Address - Country:US
Mailing Address - Phone:850-526-3314
Mailing Address - Fax:850-526-3318
Practice Address - Street 1:4719 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7839
Practice Address - Country:US
Practice Address - Phone:850-526-3314
Practice Address - Fax:850-526-3318
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106347193400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No193400000XGroupSingle Specialty