Provider Demographics
NPI:1558513168
Name:MEDURI, KALYANI R (MD)
Entity Type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:R
Last Name:MEDURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6340 FORT KING RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-2531
Mailing Address - Country:US
Mailing Address - Phone:813-782-6116
Mailing Address - Fax:813-780-1015
Practice Address - Street 1:6340 FORT KING RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-2531
Practice Address - Country:US
Practice Address - Phone:813-782-6116
Practice Address - Fax:813-780-1015
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141486207R00000X, 207RG0100X
IL036121876207R00000X
IA39329207R00000X
PAMD456022207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine