MEDICARE: SUREKA BOLLEPALLI 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	2080P0205X	Pediatric Endocrinology Physician	ME 106517	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	149KF	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1871700948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUREKA BOLLEPALLI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-7770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12901 BRUCE B DOWNS BLVD
Second Line	:	USF DIABETES CENTER, MDC 62
City	:	TAMPA
State	:	FL
Zip	:	33612-4742
Country	:	US
Telephone Number	:	813-396-2580
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/27/2010

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