Provider Demographics
NPI:1497021893
Name:TO, KIRAN KONDAVEETI (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:KONDAVEETI
Last Name:TO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRAN
Other - Middle Name:
Other - Last Name:KONDAVEETI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 TAMPA GENERAL CIR, HMT 750
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3360
Practice Address - Country:US
Practice Address - Phone:813-844-3397
Practice Address - Fax:813-844-1934
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 123059207R00000X
FLME123059208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015103200Medicaid
FL150N6OtherBLUE CROSS BLUE SHIELD
FLIF750ZMedicare PIN
FL015103200Medicaid