Healthcare Provider Details

I. General information

NPI: 1417059056
Provider Name (Legal Business Name): VENKATREDDY ALUGUBELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N LECANTO HWY
BEVERLY HILLS FL
34465-3504
US

IV. Provider business mailing address

3759 W AUGUSTA PATH
LECANTO FL
34461-7822
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-1515
  • Fax: 352-746-7767
Mailing address:
  • Phone: 352-746-1515
  • Fax: 352-746-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0055207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: