MEDICARE: MALLIKARJUNA R KAMIREDDY 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	207RC0000X	Cardiovascular Disease Physician	ME44270	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	:	1699797472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLIKARJUNA R KAMIREDDY M.D.

Provider Business Mailing Address
First Line	:	8200 JOG RD
Second Line	:	SUITE 204
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2981
Country	:	US
Telephone Number	:	561-496-3484
Fax Number	:	561-740-4763

Provider Business Practice Location Address
First Line	:	8200 JOG RD
Second Line	:	SUITE 204
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2981
Country	:	US
Telephone Number	:	561-496-3484
Fax Number	:	561-740-4763

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/23/2009

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