MEDICARE: DR. SRINIVAS KESANAKURTHY 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	221556	NY
2	207R00000X	Internal Medicine Physician	221556	NY
3	207RI0011X	Interventional Cardiology Physician	221556	NY
4	207RC0000X	Cardiovascular Disease Physician	221556	NY

General Provider Information

NPI Number	:	1770558397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SRINIVAS KESANAKURTHY M.D.

Provider Business Mailing Address
First Line	:	12508 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2234
Country	:	US
Telephone Number	:	718-581-8093
Fax Number	:	646-292-5135

Provider Business Practice Location Address
First Line	:	12508 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2234
Country	:	US
Telephone Number	:	646-335-2795
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	11/13/2023

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