Provider Demographics
NPI:1588667901
Name:TELUKUNTLA, KOTESHWAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:KOTESHWAR
Middle Name:R
Last Name:TELUKUNTLA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:3630 MANATEE AVE W
Practice Address - Street 2:STE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2557
Practice Address - Country:US
Practice Address - Phone:941-792-1881
Practice Address - Fax:941-795-3924
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME72534207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259061100Medicaid
FLP00387326OtherRR MEDICARE
FL21015YMedicare PIN
F79648Medicare UPIN