Provider Demographics
NPI:1740246974
Name:KURUVILLA, ANAND MATHAI (MD)
Entity type:Individual
Prefix:
First Name:ANAND
Middle Name:MATHAI
Last Name:KURUVILLA
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:600 ZEAGLER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3811
Practice Address - Country:US
Practice Address - Phone:386-325-8140
Practice Address - Fax:904-350-0032
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59637174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1115823OtherCARE PLUS
FL12258OtherBCBS
FL4235259OtherAETNA
P00198033OtherMEDICARE RAILROAD
FLP01451915OtherRR MEDICARE
FL1193327OtherWELLCARE
FL055904100Medicaid
FL1121651OtherWELLCARE
FLP01596516OtherRR MEDICARE
FL0571795OtherCIGNA
FL204458OtherAVMED
FLP01596516OtherRR MEDICARE
FLE87087Medicare UPIN
FL055904100Medicaid
FLCJ786UMedicare PIN
FL12258UMedicare PIN
FLCJ786ZMedicare PIN
FL1115823OtherCARE PLUS
FL1121651OtherWELLCARE
P00198033OtherMEDICARE RAILROAD
FL204458OtherAVMED
FL12258OtherBCBS
GAE85686Medicare UPIN
FL12258SMedicare PIN
FL12258JMedicare PIN
FLCJ786TMedicare PIN
FL12258MMedicare PIN
FL12258IMedicare PIN
FLCJ786VMedicare PIN
FL12258NMedicare PIN