Individual
PREM SRINIVAS SUBRAMANIYAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
410 LIONEL WAY STE 201, DAVENPORT, FL 33837-7809
(863) 422-5331
Mailing address
410 LIONEL WAY STE 201, DAVENPORT, FL 33837-7809
(863) 422-5331
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BP10036946
TX
207RC0000X
Cardiovascular Disease Physician
254528
MA
207RI0011X
Interventional Cardiology Physician
Primary
ME165319
FL
207RI0011X
Interventional Cardiology Physician
TP441
KY
Other
Enumeration date
09/28/2010
Last updated
03/18/2024
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