Provider Demographics
NPI:1497719306
Name:RAMACHANDRUNI, SRIKANTH (MD)
Entity Type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:
Last Name:RAMACHANDRUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221078
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1078
Mailing Address - Country:US
Mailing Address - Phone:321-917-9263
Mailing Address - Fax:321-396-6916
Practice Address - Street 1:5950 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414
Practice Address - Country:US
Practice Address - Phone:321-917-9263
Practice Address - Fax:321-396-6916
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48600207RI0200X
TXP3662207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262113400Medicaid
FL262113400Medicaid
FL03273XMedicare ID - Type Unspecified