Provider Demographics
NPI:1477945186
Name:MKMD PHYSIATRY CONSULTANTS LLC
Entity Type:Organization
Organization Name:MKMD PHYSIATRY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KATUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-631-7496
Mailing Address - Street 1:3189 DRUMMOND WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3189 DRUMMOND WAY
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6071
Practice Address - Country:US
Practice Address - Phone:248-631-7496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty