Provider Demographics
NPI:1134185820
Name:KUNDRA, ANITA (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:KUNDRA
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 1:2595 TAMPA RD
Mailing Address - Street 2:STE S & T
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3152
Mailing Address - Country:US
Mailing Address - Phone:727-781-4299
Mailing Address - Fax:727-781-5387
Practice Address - Street 1:2595 TAMPA RD
Practice Address - Street 2:STE S & T
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-781-4299
Practice Address - Fax:727-781-5387
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377725100Medicaid
FL377725100Medicaid
FL26839ZMedicare ID - Type Unspecified