MEDICARE: PRASAD KORLIPARA. 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	ME54509	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

General Provider Information

NPI Number	:	1386035301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRASAD KORLIPARA. M.D.

Provider Business Mailing Address
First Line	:	1331 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4825
Country	:	US
Telephone Number	:	772-489-5900
Fax Number	:	772-489-2086

Provider Business Practice Location Address
First Line	:	1331 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4825
Country	:	US
Telephone Number	:	772-489-5900
Fax Number	:	772-489-2086

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANJANAYA PRASAD RAO KORLIPARA
Credential	:	M.D.
Telephone Number	:	772-489-5900

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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