Healthcare Provider Details

I. General information

NPI: 1992198501
Provider Name (Legal Business Name): KRISHNA KASTURI, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2015
Last Update Date: 07/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10502 SPRING HILL DR
SPRING HILL FL
34608-5046
US

IV. Provider business mailing address

10502 SPRING HILL DR
SPRING HILL FL
34608-5046
US

V. Phone/Fax

Practice location:
  • Phone: 352-277-0966
  • Fax: 352-282-3969
Mailing address:
  • Phone: 352-277-0966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME112279
License Number StateFL

VIII. Authorized Official

Name: DR. KRISHNA SAGAR KASTURI
Title or Position: MANAGER
Credential: M.D
Phone: 352-277-0966