Provider Demographics
NPI:1972615599
Name:PATTISAPU, ANNAPURNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNAPURNA
Middle Name:
Last Name:PATTISAPU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 N WESTMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3464 AVALON PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7363
Practice Address - Country:US
Practice Address - Phone:407-635-3021
Practice Address - Fax:321-203-4608
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0576867005Medicaid
FL4210891OtherAETNA
FL11569OtherBLUE CROSS & BLUE SHIELD
FL11569OtherBLUE CROSS & BLUE SHIELD
FLE85466Medicare UPIN