Provider Demographics
NPI:1013150051
Name:KOLLI, HARI K (MBBS (MD))
Entity type:Individual
Prefix:DR
First Name:HARI
Middle Name:K
Last Name:KOLLI
Suffix:
Gender:M
Credentials:MBBS (MD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 MITCHAM DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5479
Mailing Address - Country:US
Mailing Address - Phone:850-878-1171
Mailing Address - Fax:850-942-1291
Practice Address - Street 1:2617 MITCHAM DR STE 102
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5479
Practice Address - Country:US
Practice Address - Phone:850-878-1171
Practice Address - Fax:850-942-1291
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106241207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060754100Medicaid
FL002627600Medicaid