Provider Demographics
NPI:1518136662
Name:MALLI KAMIREDDY M D P A
Entity Type:Organization
Organization Name:MALLI KAMIREDDY M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-496-3484
Mailing Address - Street 1:5162 LINTON BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6567
Mailing Address - Country:US
Mailing Address - Phone:561-496-3484
Mailing Address - Fax:561-499-1643
Practice Address - Street 1:5162 LINTON BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-496-3484
Practice Address - Fax:561-499-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44270207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0453Medicare PIN
FLD57213Medicare UPIN