Mallik A Piduru, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME0044053 Issued in FL

Practice address

11373 Cortez Blvd
Suite 201
Brooksville, FL 34613-5414

Phone

(352) 596-7860

Fax

(352) 597-3657

NPI assigned

Feb 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Coast Surgical Associates

  • Surgery Physician
  • Brooksville, FL
  • NPI 1023050739
  NPD
• Access Healthcare LLC

  • General Practice Physician
  • Spring Hill, FL
  • NPI 1912949561
  NPD (past)

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1265405997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15215 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346136072",
            "telephone_number": "352-799-0046",
            "fax_number": "727-861-1881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11373 CORTEZ BLVD",
            "address_2": "SUITE 201",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135414",
            "telephone_number": "352-596-7860",
            "fax_number": "352-597-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIDURU",
        "first_name": "MALLIK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME0044053",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "FL",
            "license": "ME0044053",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "P00984624",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036160700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "26064",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR ATTACHED TO GRP# CH7269",
            "identifier": "P00867800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "165252",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ana Roberta Philipsen, ACUPUNCTURE PHYSICIA
• Phoenix Counseling Service Inc
• Physical Therapy Services of Brooksville Inc
• Physician Partners Network PA
• Physician Partners Network PA
• Edward Russell Pierce
• Isabel Pietras
• Debra Jean Pilla
• Pine Brook Pharmacy LLC
• Pine Brook Pharmacy LLC

• Surgery Physician in Brooksville, FL
• Providers in Brooksville, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.