Individual
SAI PAVAN KUMAR VEMULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11375 CORTEZ BLVD, BROOKSVILLE, FL 34613-5409
(630) 605-3052
Mailing address
11375 CORTEZ BLVD, BROOKSVILLE, FL 34613-5409
(630) 605-3052
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.169617
IL
390200000X
Student in an Organized Health Care Education/Training Program
30148
FL
Other
Enumeration date
04/08/2020
Last updated
08/19/2024
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