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General NPI Number Information
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NPI Number | 1740246974
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Entity Type | Individual
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Provider Name | ANAND MATHAI KURUVILLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 600 ZEAGLER DR SUITE 2
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City | PALATKA
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State | FL
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Zip | 32177-3811
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Country | US
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Telephone | 386-325-8140
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Fax | 904-350-0032
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | ME59637
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME59637
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License Number State | FL
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