Srikruthi Kakulavarapu, M.D., M.B.A.
Individual provider Active NPI Family Medicine Physician · Kenneth City, FL
NPI 1619554342 · NPPES record last updated May 16, 2024
Key facts
- NPI
- 1619554342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- ME165698 (FL)
- Practice address
- 4390 66TH St N
Kenneth City, FL 33709-4920 - Phone
- (727) 513-4100
- Fax
- (727) 565-4979
- NPI assigned
- Mar 27, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240328000157 | FL | Practitioner - General Practice | 2668819475 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Business Administration, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME165698 | FL | MD | Family Medicine Physician |
Practice roles (5 of 7)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dedicated Senior Medical Centers of Florida, LLC | Current |
Accepting new patients | |
| Dedicated Senior Medical Center of Florida, LLC | Current |
Accepting new patients | |
| Dedicated Senior Medical Center of Florida, LLC | Current |
Accepting new patients | |
| Dedicated Senior Medical Center of Florida, LLC | Current |
Accepting new patients | |
| Dedicated Senior Medical Centers of Florida, LLC | Past |
Accepting new patients |
Locations
4390 66th St N
Kenneth City, FL 33709
Phone (727) 513-4100
206 N Florida Ave
Lakeland, FL 33801
Phone (863) 209-7003
4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003
1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760
2805 54th Ave N
Ste 500
St Petersburg, FL 33714
Phone (727) 341-5800
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | ME165698 | FL | Yes |
Addresses
Primary practice location
4390 66TH St N
Kenneth City, FL 33709-4920
Mailing address
4390 66TH St N
Kenneth City, FL 33709-4920
Phone (727) 513-4100
Other providers in Kenneth City, FL
- Kathryn Jensen
- JMJ Labs LLC Dba Arcpoint Labs of Saint Petersburg
- John Bowman Dba/Choice Medical Supply
- Jonathan B May DPM PA
- Jessica Suzann Kaczar
- Lalit Kalra
- Felisha Renise King
- Leonard Klaskow
- Amber Knight
- Jennifer Marie Krouse
All providers in Kenneth City, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.