Provider Demographics
NPI:1336147487
Name:SUNDARESH, KORAVANGALA K (MD)
Entity Type:Individual
Prefix:DR
First Name:KORAVANGALA
Middle Name:K
Last Name:SUNDARESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1166
Mailing Address - Street 2:
Mailing Address - City:ELFERS
Mailing Address - State:FL
Mailing Address - Zip Code:34680-1166
Mailing Address - Country:US
Mailing Address - Phone:727-845-3890
Mailing Address - Fax:727-846-0112
Practice Address - Street 1:5131 WESTSHORE DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-8006
Practice Address - Country:US
Practice Address - Phone:727-845-3890
Practice Address - Fax:727-846-0112
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42812207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069547500Medicaid
FLD86021Medicare UPIN
FL53677Medicare ID - Type Unspecified