Provider Demographics
NPI:1588623334
Name:SOMPALLI, VINEEL (MD)
Entity Type:Individual
Prefix:
First Name:VINEEL
Middle Name:
Last Name:SOMPALLI
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 1:11616 LAKE UNDERHILL ROAD
Mailing Address - Street 2:SUITE # 215
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825
Mailing Address - Country:US
Mailing Address - Phone:407-482-7788
Mailing Address - Fax:407-482-8698
Practice Address - Street 1:11616 LAKE UNDERHILL ROAD.
Practice Address - Street 2:SUITE # 215
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825
Practice Address - Country:US
Practice Address - Phone:407-482-7788
Practice Address - Fax:407-482-8698
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85171207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000384680OtherANTHEM PROVIDER NUMBER
IN10749554OtherCAQH NUMBER
IN10749554OtherCAQH NUMBER
FL815490000Medicare PIN
FLH67392Medicare UPIN
INP00281545Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER
INH67392Medicare UPIN
FL000962800Medicaid
IN921480GGMedicare PIN
IN10749554OtherCAQH NUMBER
IN000000384680OtherANTHEM PROVIDER NUMBER
IN815520RRRRMedicare PIN