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NPI Code Detail

MEDICARE: DR. KOTESHWAR R TELUKUNTLA MD

MEDICARE: DR. KOTESHWAR R TELUKUNTLA 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
1207RH0000XHematology (Internal Medicine) PhysicianME72534FL
2207RX0202XMedical Oncology PhysicianME72534FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00387326OTHERFLRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588667901
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KOTESHWAR R TELUKUNTLA MD
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number : 239-278-3350
Provider Business Practice Location Address
First Line : 3630 MANATEE AVE W
Second Line : STE B
City : BRADENTON
State : FL
Zip : 34205-2557
Country : US
Telephone Number : 941-792-1881
Fax Number : 941-795-3924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 09/02/2022

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