MEDICARE: PPR&D BIOMARKERS INC,

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	291U00000X	Clinical Medical Laboratory		FL

General Provider Information

NPI Number	:	1801898986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PPR&D BIOMARKERS INC,

Provider Business Mailing Address
First Line	:	3802 SPECTRUM BLVD
Second Line	:	SUITE 141
City	:	TAMPA
State	:	FL
Zip	:	33620-5920
Country	:	US
Telephone Number	:	813-866-5692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3802 SPECTRUM BLVD
Second Line	:	SUITE 141
City	:	TAMPA
State	:	FL
Zip	:	33620-5920
Country	:	US
Telephone Number	:	813-866-5692
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAVI KOTHAPALLI
Credential	:	M.SC., PH.D
Telephone Number	:	813-866-5692

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	08/22/2020

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