Healthcare Provider Details

I. General information

NPI: 1790913382
Provider Name (Legal Business Name): SIVA MOHAN KROTHAPALLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CENTERVILLE RD
TALLAHASSEE FL
32308-4379
US

IV. Provider business mailing address

1717 6TH AVE S
BIRMINGHAM AL
35233-1801
US

V. Phone/Fax

Practice location:
  • Phone: 850-216-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number41376
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: