Provider Demographics
NPI:1417940297
Name:KUMAR, KEERTINI (M D)
Entity Type:Individual
Prefix:
First Name:KEERTINI
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:KEERTHINI
Other - Middle Name:
Other - Last Name:NARAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-0577
Mailing Address - Country:US
Mailing Address - Phone:352-304-8980
Mailing Address - Fax:352-304-9885
Practice Address - Street 1:8618 SW 103RD STREET RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7705
Practice Address - Country:US
Practice Address - Phone:352-304-9880
Practice Address - Fax:352-304-9885
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267314200Medicaid
FL267314200Medicaid
FL29229AMedicare ID - Type Unspecified