Provider Demographics
NPI:1992860597
Name:KATUKURI, VINAY K (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:K
Last Name:KATUKURI
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 1:9462 BECKER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-4304
Mailing Address - Country:US
Mailing Address - Phone:407-518-7277
Mailing Address - Fax:
Practice Address - Street 1:809 E OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-703-3300
Practice Address - Fax:407-703-3302
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136923207RG0100X
CAC141228207RG0100X
MI4301077924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4673474Medicaid
MI110F37698OtherBCBSM
MII23319Medicare UPIN
MI0F376980281Medicare ID - Type Unspecified