Piduru, Mallik A

Piduru, Mallik A is an individual health care provider with primary practice located at 11373 Cortez Blvd Suite 201, Brooksville FL 34613-5414. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Piduru, Mallik A can be contacted via phone (352) 596-7860.

Contact Information

Primary practice address
11373 Cortez Blvd Suite 201 Brooksville FL 34613-5414
Phone: (352) 596-7860
Fax: (352) 597-3657
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X ME0044053 Florida
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X ME0044053 Florida

Profile Details

NPI number 1265405997
LBN Legal business name Piduru, Mallik A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Jan 24th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265405997 NPPES
Florida Other P00984624 RR MCR
Florida MEDICAID 036160700 RR MCR
Florida Other 26064 RR MCR
Florida Other P00867800 RR MCR
Florida Other 165252 RR MCR

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