MEDICARE: PALLAVI R. CHERUKUPALLY MD

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	208100000X	Physical Medicine & Rehabilitation Physician	057788	GA
2	208100000X	Physical Medicine & Rehabilitation Physician	ME127634	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144273723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PALLAVI R. CHERUKUPALLY MD

Provider Business Mailing Address
First Line	:	10920 MOSS PARK RD STE 218
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-6087
Country	:	US
Telephone Number	:	407-730-5600
Fax Number	:	407-289-4036

Provider Business Practice Location Address
First Line	:	10920 MOSS PARK RD STE 218
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-6087
Country	:	US
Telephone Number	:	407-730-5600
Fax Number	:	407-289-4036

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/17/2018

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