NPIMap

Organization Active NPI

Kanumuri Medical Group PA

  • Anesthesiology Physician
  • Lake Wales, FL
National Provider Identifier
1093761504
Registry record updated Oct 18, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
KANUMURI MEDICAL GROUP PA
Practice address
410 S 11TH St
Lake Wales, FL 33853-4203
Phone
(863) 402-0064
Fax
(866) 746-1525
NPI assigned
May 26, 2006
Last updated
Oct 18, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nageswararo V Kanumuri, MD
Title
President/Physician
Phone
(863) 402-0064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X FL Primary

Addresses

Primary practice location

410 S 11TH St
Lake Wales, FL 33853-4203

Mailing address

PO Box 2327
Lake Wales, FL 33859-2327
Phone (863) 402-0064

National Provider Directory

National Provider Directory

Locations

107 Park Place Blvd
Davenport, FL 33837
Phone (863) 419-2812

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1093761504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2327",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338592327",
            "telephone_number": "863-402-0064",
            "fax_number": "866-746-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-402-0064",
            "fax_number": "866-746-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANUMURI MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "KANUMURI",
        "authorized_official_first_name": "NAGESWARARO",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "863-402-0064",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.