Provider Demographics
NPI:1417149873
Name:AMARAVADI, KAMALAKAR (MD)
Entity Type:Individual
Prefix:
First Name:KAMALAKAR
Middle Name:
Last Name:AMARAVADI
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 1:2920 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0820
Mailing Address - Country:US
Mailing Address - Phone:352-553-6746
Mailing Address - Fax:
Practice Address - Street 1:7558 SW 61ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-8323
Practice Address - Country:US
Practice Address - Phone:352-553-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279858100Medicaid
FLAF560ZMedicare PIN