Healthcare Provider Details

I. General information

NPI: 1851538375
Provider Name (Legal Business Name): RK MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WATERMAN WAY
TAVARES FL
32778-5266
US

IV. Provider business mailing address

PO BOX 2056
MOUNT DORA FL
32756-2056
US

V. Phone/Fax

Practice location:
  • Phone: 407-330-8368
  • Fax:
Mailing address:
  • Phone: 407-330-8368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME102779
License Number StateFL

VIII. Authorized Official

Name: KARUNA GADDAM
Title or Position: PRESIDENT
Credential: MD
Phone: 407-330-8368