MEDICARE: KV SUNDARESH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	ME0042812	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497146716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KV SUNDARESH MD

Provider Business Mailing Address
First Line	:	5810 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-6050
Country	:	US
Telephone Number	:	727-845-3890
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 STATE ROAD 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-6050
Country	:	US
Telephone Number	:	727-845-3890
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KORAVANGALA V SUNDARESH
Credential	:	M.D.
Telephone Number	:	727-457-5522

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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