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NPI Code Detail

MEDICARE: DR. KAMALASANI PANCHAMIRTHAM M.D.

MEDICARE: DR. KAMALASANI PANCHAMIRTHAM M.D.
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
1208000000XPediatrics PhysicianME0069086FL

Other Identifiers

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

General Provider Information

NPI Number : 1740246065
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAMALASANI PANCHAMIRTHAM M.D.
Provider Business Mailing Address
First Line : 1900 27TH ST
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-3383
Country : US
Telephone Number : 772-794-7400
Fax Number : 772-794-7453
Provider Business Practice Location Address
First Line : 1900 27TH ST
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-3383
Country : US
Telephone Number : 772-794-7400
Fax Number : 772-794-7453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 12/11/2012

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