Basic Information
| Provider Information | |||||||||
| NPI: | 1205845633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUMMADAPU | ||||||||
| FirstName: | RAMKISHAN | ||||||||
| MiddleName: | RAO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 WEKIVA COMMONS CIRCLE | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074649516 | ||||||||
| FaxNumber: | 4074649519 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E ROLLINS AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074649516 | ||||||||
| FaxNumber: | 4074649519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | ME0096494 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | ME96494 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 56386 | 01 | FL | BCBS | OTHER | 276135100 | 05 | FL | MEDICAID |