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General NPI Number Information
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NPI Number | 1205024254
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Entity Type | Individual
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Provider Name | KIRANMAYI PALLA MUDDASANI
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Gender | Female
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 4306 ALTON RD
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2840
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Country | US
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Telephone | 305-674-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 CALAIS DR
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City | MIAMI BEACH
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State | FL
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Zip | 33141-3510
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Country | US
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Telephone | 203-843-7761
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Fax |
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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 | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | ME 124298
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License Number State | FL
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