MEDICARE: DR. KALYANI GADDIPATI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME74348	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	100016196	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	5702044007	OTHER	CIGNA
2	43554	OTHER	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	3542	OTHER	FHHS
6	2745785	OTHER	AETNA

General Provider Information

NPI Number	:	1033165964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALYANI GADDIPATI M.D.

Provider Business Mailing Address
First Line	:	917 RINEHART RD
Second Line	:	SUITE 2051
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4802
Country	:	US
Telephone Number	:	407-936-2444
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 RINEHART RD
Second Line	:	SUITE 2051
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4802
Country	:	US
Telephone Number	:	407-936-2444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	05/15/2024

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Directions to “ DR. KALYANI GADDIPATI M.D.” Practice Location

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