Individual
VINOD R MIRYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 OLD CAMP RD, BLDG 210, THE VILLAGES, FL 32162-5604
(352) 751-3356
(352) 751-3359
Mailing address
308 W HIGHLAND BLVD, INVERNESS, FL 34452-4716
(352) 726-8353
(352) 726-5038
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME75516
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10715924
CAQH
FL
05
—
254028200
—
FL
01
—
269859500
MEDICAID GROUP
FL
01
—
43462
BCBS OF FL
FL
01
—
7390633
CIGNA
FL
01
—
77940
BCBS OF FL GROUP ID
FL
01
—
CF1416
MEDICARE RR GROUP
FL
01
—
ME75516
STATE MEDICAL LICENSE
FL
01
—
P00455415
MEDICARE RR
FL
Enumeration date
05/29/2007
Last updated
10/11/2023
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