Organization
FOUR CORNERS INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SRINATH REDDY KOSANAM MD (OWNER)
(863) 424-8900
Entity
Organization
Contact information
Practice address
106 POLO PARK EAST BLVD, DAVENPORT, FL 33897-9407
(863) 424-8900
(863) 424-8823
Mailing address
10603 EMERALD CHASE DR, ORLANDO, FL 32836-5855
(407) 217-5353
(407) 217-5353
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME78339
FL
Other
Enumeration date
05/24/2006
Last updated
10/20/2010
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