Healthcare Provider Details

I. General information

NPI: 1336769660
Provider Name (Legal Business Name): MURALI KRISHNA IYYANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 RINEHART RD STE 2080
LAKE MARY FL
32746-2541
US

IV. Provider business mailing address

392 RINEHART RD STE 2080
LAKE MARY FL
32746-2541
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-650-1307
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-650-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME168359
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME168359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: