Provider Demographics
NPI:1881435030
Name:KURUVILLA ONCOLOGY, LLC
Entity type:Organization
Organization Name:KURUVILLA ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:M
Authorized Official - Last Name:KURUVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-325-8140
Mailing Address - Street 1:PO BOX 160219
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0219
Mailing Address - Country:US
Mailing Address - Phone:770-693-2622
Mailing Address - Fax:
Practice Address - Street 1:600 ZEAGLER DR
Practice Address - Street 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty