Provider Demographics
NPI:1205979218
Name:KOLINJIVADI, JEEVASUNDARI R (MD)
Entity type:Individual
Prefix:DR
First Name:JEEVASUNDARI
Middle Name:R
Last Name:KOLINJIVADI
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 1:10539 GREENCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5200
Mailing Address - Country:US
Mailing Address - Phone:813-926-0218
Mailing Address - Fax:
Practice Address - Street 1:LABORATORY CORPORATION OF AMERICA
Practice Address - Street 2:5610 WEST LASALLE STREET
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-289-5227
Practice Address - Fax:813-286-2684
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 54634174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist