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General NPI Number Information
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NPI Number | 1154313476
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Entity Type | Individual
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Provider Name | SRINATH REDDY KOSANAM M.D
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 106 POLO PARK EAST BLVD
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City | DAVENPORT
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State | FL
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Zip | 33897-9407
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Country | US
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Telephone | 863-424-8900
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Fax | 863-424-8823
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Provider Business Mailing Address
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Address Line | 10603 EMERALD CHASE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5855
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Country | US
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Telephone | 863-424-8900
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Fax | 863-424-8823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME78339
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License Number State | FL
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