Healthcare Provider Details

I. General information

NPI: 1194888479
Provider Name (Legal Business Name): KAVITHA GUDUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 8TH ST N
NAPLES FL
34102-5519
US

IV. Provider business mailing address

PO BOX 111600
NAPLES FL
34108-0127
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-3306
  • Fax:
Mailing address:
  • Phone: 239-649-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME89492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: