Provider Demographics
NPI:1588822571
Name:MURALI M ANGIREKULA MD PA
Entity Type:Organization
Organization Name:MURALI M ANGIREKULA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-527-2500
Mailing Address - Street 1:4065 N LECANTO HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-3555
Mailing Address - Country:US
Mailing Address - Phone:352-527-2500
Mailing Address - Fax:
Practice Address - Street 1:4065 N LECANTO HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3555
Practice Address - Country:US
Practice Address - Phone:352-527-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21026OtherBLUE CROSS BLUE SHIEDL
FL252044300Medicaid
FLG33868Medicare UPIN
FL252044300Medicaid