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General NPI Number Information
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NPI Number | 1023264447
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Entity Type | Organization
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Legal Business Name | DESARAJU & KOMPELLA, P.A.
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 6201 N SUNCOAST BLVD
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-6712
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Country | US
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Telephone | 352-601-2375
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Fax | 813-200-3667
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Provider Business Mailing Address
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Address Line | PO BOX 1355
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City | HERNANDO
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State | FL
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Zip | 34442-1355
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Country | US
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Telephone | 352-601-2375
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Fax | 813-200-3667
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHAKRADHAR DESARAJU
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Credential | M.D.
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Telephone | 352-601-2375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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