Healthcare Provider Details

I. General information

NPI: 1922100346
Provider Name (Legal Business Name): KOTESWARARAO VEMURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 58TH ST N
ST PETERSBURG FL
33710-6325
US

IV. Provider business mailing address

960 58TH ST N
ST PETERSBURG FL
33710-6325
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7778
  • Fax: 727-820-7779
Mailing address:
  • Phone: 727-820-7778
  • Fax: 727-820-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number4301071367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: