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General NPI Number Information
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NPI Number | 1881435030
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Entity Type | Organization
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Legal Business Name | KURUVILLA ONCOLOGY, LLC
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 600 ZEAGLER DR
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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 | PO BOX 160219
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32716-0219
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Country | US
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Telephone | 770-693-2622
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | ANAND M KURUVILLA
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Credential | MD
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Telephone | 386-325-8140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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