Provider Demographics
NPI:1679710073
Name:PURIMETLA, VENKATA MURALI KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:MURALI KRISHNA
Last Name:PURIMETLA
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 1:1002 S DILLARD ST STE 122
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3991
Mailing Address - Country:US
Mailing Address - Phone:407-656-4222
Mailing Address - Fax:407-656-7117
Practice Address - Street 1:1002 S DILLARD ST STE 122
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3991
Practice Address - Country:US
Practice Address - Phone:407-656-4222
Practice Address - Fax:407-656-7117
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127651207R00000X
NH14814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209755Medicaid
FL018109500Medicaid
FLIQ957ZMedicare PIN
PENDINGMedicare PIN