Healthcare Provider Details

I. General information

NPI: 1063639516
Provider Name (Legal Business Name): MRUNALINI KAVURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 LAKE IDA RD # 5
DELRAY BEACH FL
33445-2443
US

IV. Provider business mailing address

2150 LAKE IDA RD # 5
DELRAY BEACH FL
33445-2443
US

V. Phone/Fax

Practice location:
  • Phone: 561-330-3026
  • Fax: 561-330-3027
Mailing address:
  • Phone: 561-330-3026
  • Fax: 561-330-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number4301084122
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME98282
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: