Individual
AJITH KUMAR POTLURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3391 W VINE ST STE 303, KISSIMMEE, FL 34741-4665
(407) 962-7449
(407) 932-0303
Mailing address
3391 W VINE ST STE 303, KISSIMMEE, FL 34741-4665
(407) 962-7449
(407) 932-0303
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME115004
FL
2084P0805X
Geriatric Psychiatry Physician
ME115004
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009920000
—
FL
Enumeration date
02/27/2006
Last updated
06/01/2022
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