Individual
DR. VIJAY KATUKURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7332 OFFICE PARK PL STE 103, MELBOURNE, FL 32940-8241
(321) 327-9788
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 327-9788
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME111580
FL
208VP0014X
Interventional Pain Medicine Physician
ME111580
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100992200
—
FL
01
—
14J9M
BCBS
FL
01
—
9399867
AETNA
FL
01
—
M4265
MEDICARE HF
FL
Enumeration date
06/04/2008
Last updated
09/21/2021
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