Provider Demographics
NPI:1619554342
Name:KAKULAVARAPU, SRIKRUTHI (MD, MBA)
Entity type:Individual
Prefix:
First Name:SRIKRUTHI
Middle Name:
Last Name:KAKULAVARAPU
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4920
Mailing Address - Country:US
Mailing Address - Phone:727-513-4100
Mailing Address - Fax:727-565-4979
Practice Address - Street 1:4390 66TH ST N
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-4920
Practice Address - Country:US
Practice Address - Phone:727-513-4100
Practice Address - Fax:727-565-4979
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME165698207Q00000X
390200000X
FLTRN32311390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine