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General NPI Number Information
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NPI Number | 1215018627
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Entity Type | Individual
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Provider Name | ARUN K PENUKONDA MD, FRCS, PA
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 323 DEL PRADO BLVD. S. SUITE 100
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City | CAPE CORAL
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State | FL
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Zip | 33990
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Country | US
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Telephone | 239-574-4110
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Fax | 239-673-6053
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE FL 2
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City | FORT MYERS
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State | FL
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Zip | 33901-9342
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Country | US
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Telephone | 239-574-4110
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Fax | 239-574-5897
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME0062366
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME0062366
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License Number State | FL
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