Individual
MADHUSUDANA KALAKOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1920 NORTH CENTRAL AVE, KISSIMMEE, FL 34741-2373
(407) 931-2991
(407) 933-4699
Mailing address
1920 N CENTRAL AVE, KISSIMMEE, FL 34741-2331
(407) 931-2991
(407) 933-4699
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0061078
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
370719900
—
FL
01
—
593368006
TAX ID
FL
01
—
ME0061078
MEDICAL LICENSE
FL
Enumeration date
08/20/2006
Last updated
03/07/2023
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