| Mallikarjuna Nandyala Md Pa | |
|
8313 W Hillsborough Ave Ste 300 Tampa FL 33615-3819 | |
| (813) 884-0222 | |
| (813) 884-0080 |
| Full Name | Mallikarjuna Nandyala Md Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 8313 W Hillsborough Ave Ste 300, Tampa, Florida |
| Authorized Official Name and Position | Mallikarjuna Nandyala (OWNER) |
| Authorized Official Contact | 8138840222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mallikarjuna Nandyala Md Pa 14749 Waterchase Blvd Tampa FL 33626-3318 Ph: (813) 884-0222 | Mallikarjuna Nandyala Md Pa 8313 W Hillsborough Ave Ste 300 Tampa FL 33615-3819 Ph: (813) 884-0222 |
| NPI Number | 1427383512 |
|---|---|
| Provider Enumeration Date | 10/07/2009 |
| Last Update Date | 01/30/2013 |
| Medicare PECOS PAC ID | 3779622394 |
|---|---|
| Medicare Enrollment ID | O20091120000130 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427383512 | NPI | - | NPPES |
| 250560600 | Medicaid | FL | |
| 110244550 | Other | FL | RAILROAD MEDICARE |
| ME0070271 | Other | FL | MEDICAL STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0070271 (Florida) | Primary |
| Provider Name | Mallikarjuna Nandyala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023081676 PECOS PAC ID: 5698661247 Enrollment ID: I20040223000496 |
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