Provider Demographics
NPI:1629099163
Name:SUDARSAN KAMISETTY, M.D.,P.A
Entity type:Organization
Organization Name:SUDARSAN KAMISETTY, M.D.,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDARSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KAMISETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-655-7726
Mailing Address - Street 1:681 W. LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-655-7726
Mailing Address - Fax:813-655-5617
Practice Address - Street 1:681 W. LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5911
Practice Address - Country:US
Practice Address - Phone:813-655-7726
Practice Address - Fax:813-655-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty