Individual
PRABHAKARA KUNAMNENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1825 SALK AVE, TAVARES, FL 32778-4311
(352) 343-1158
(352) 343-8106
Mailing address
PO BOX 1289, TAVARES, FL 32778-1289
(352) 343-1158
(352) 343-8106
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
223231
NY
207RC0000X
Cardiovascular Disease Physician
Primary
ME101637
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001219100
—
FL
Enumeration date
06/12/2006
Last updated
04/22/2022
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