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General NPI Number Information
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NPI Number | 1265751879
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Entity Type | Organization
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Legal Business Name | ARUN K. PENUKONDA, M.D., F.R.C.S., P.A..
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 12/16/2011
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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 | 239-574-5897
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Provider Business Mailing 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 | 239-574-5897
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARUN K PENUKONDA
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Credential | M.D.
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Telephone | 239-574-4110
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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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