Provider Demographics
NPI:1497146716
Name:KV SUNDARESH MD
Entity Type:Organization
Organization Name:KV SUNDARESH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KORAVANGALA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SUNDARESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-457-5522
Mailing Address - Street 1:5810 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-6050
Mailing Address - Country:US
Mailing Address - Phone:727-845-3890
Mailing Address - Fax:
Practice Address - Street 1:5810 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-6050
Practice Address - Country:US
Practice Address - Phone:727-845-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042812207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069547500Medicaid
FL069547500Medicaid