Healthcare Provider Details

I. General information

NPI: 1205845633
Provider Name (Legal Business Name): RAMKISHAN RAO GUMMADAPU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS AVE
ORLANDO FL
32803
US

IV. Provider business mailing address

515 WEKIVA COMMONS CIRCLE
APOPKA FL
32712
US

V. Phone/Fax

Practice location:
  • Phone: 407-464-9516
  • Fax: 407-464-9519
Mailing address:
  • Phone: 407-464-9516
  • Fax: 407-464-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME0096494
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME96494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: