Provider Demographics
NPI:1770519068
Name:KEERTINI KUMAR, MD, PA
Entity type:Organization
Organization Name:KEERTINI KUMAR, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEERTINI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-304-8980
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-0577
Mailing Address - Country:US
Mailing Address - Phone:352-304-8980
Mailing Address - Fax:352-304-8985
Practice Address - Street 1:8618 SW 103RD STREET RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7705
Practice Address - Country:US
Practice Address - Phone:352-304-8980
Practice Address - Fax:352-304-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267314200Medicaid
FLK7240Medicare ID - Type Unspecified
FL267314200Medicaid