Provider Demographics
NPI:1609917665
Name:AKELLA, JAGAN S (MD)
Entity Type:Individual
Prefix:
First Name:JAGAN
Middle Name:S
Last Name:AKELLA
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:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34206-1135
Mailing Address - Country:US
Mailing Address - Phone:941-794-9000
Mailing Address - Fax:941-729-1382
Practice Address - Street 1:6400 MANATEE AVE W
Practice Address - Street 2:STE A
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2357
Practice Address - Country:US
Practice Address - Phone:941-794-9000
Practice Address - Fax:941-729-1382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101828207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101828OtherSTATE LICENSE NUMBER