MEDICARE: RAMYA KRISHNA POTTI MUTYAPU 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	208000000X	Pediatrics Physician	161674	FL
2	208000000X	Pediatrics Physician	125066677	IL

General Provider Information

NPI Number	:	1952753568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMYA KRISHNA POTTI MUTYAPU MD

Provider Business Mailing Address
First Line	:	870 CLARK ST STE 1000
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-9270
Country	:	US
Telephone Number	:	407-977-1135
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 CLARK ST STE 1000
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-9270
Country	:	US
Telephone Number	:	407-977-1135
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	01/21/2026

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