MEDICARE: ANAND MATHAI KURUVILLA 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
1	174400000X	Specialist	ME59637	FL
2	2085R0001X	Radiation Oncology Physician	ME59637	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00198033	OTHER		MEDICARE RAILROAD
5	P01451915	OTHER	FL	RR MEDICARE
9	P01596516	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1115823	OTHER	FL	CARE PLUS
2	12258	OTHER	FL	BCBS
3	4235259	OTHER	FL	AETNA
6	1193327	OTHER	FL	WELLCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1121651	OTHER	FL	WELLCARE
10	0571795	OTHER	FL	CIGNA
11	204458	OTHER	FL	AVMED
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740246974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAND MATHAI KURUVILLA M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	600 ZEAGLER DR
Second Line	:	SUITE 2
City	:	PALATKA
State	:	FL
Zip	:	32177-3811
Country	:	US
Telephone Number	:	386-325-8140
Fax Number	:	904-350-0032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	05/04/2016

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