Provider Demographics
NPI:1467470583
Name:MUNIYAPPA, KISHOR KUMAR KALLAHALLI (MBBS MD)
Entity Type:Individual
Prefix:DR
First Name:KISHOR KUMAR
Middle Name:KALLAHALLI
Last Name:MUNIYAPPA
Suffix:
Gender:M
Credentials:MBBS MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 KELCEY CT STE 103
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4012 KELCEY CT STE 103
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5986
Practice Address - Country:US
Practice Address - Phone:850-297-0351
Practice Address - Fax:850-297-0352
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240274207R00000X
VA390200000X
FLME120003207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467470583Medicaid
P00770336Medicare PIN
VA1467470583Medicaid
VA021536V16Medicare PIN