Provider Demographics
NPI:1477723781
Name:KARUMANCHI, PRUDHVI RAJAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PRUDHVI RAJAN
Middle Name:
Last Name:KARUMANCHI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 W DR. MARTIN LUTHER KING JR. BLVD 3 EAST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-337-7535
Mailing Address - Fax:785-354-6349
Practice Address - Street 1:3001 W. DR. MARTIN LUTHER KING JR. BLVD
Practice Address - Street 2:3 EAST
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-337-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126502208M00000X
IL125050813207R00000X
IL036126553207RG0300X
KS04-35231208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018568200Medicaid
KS200738900AMedicaid
FL511630601949-003OtherMEDICARE
KS068002136OtherMEDICARE PTAN
IL036126553OtherSTATE MEDICAL BOARD
IL125050813OtherPHYSICIAN TEMPORARY LICEN
FLME126502OtherSTATE MEDICAL BOARD