Provider Demographics
NPI:1447283015
Name:KANTAMNENI, ANURADHA (MD)
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:KANTAMNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:876 SAXON BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8214
Practice Address - Country:US
Practice Address - Phone:386-774-0491
Practice Address - Fax:386-774-0492
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0533210001OtherDMERC
ILIL2613OtherMEDICARE GROUP PTAN
ILI21842Medicare UPIN
ILK12686Medicare PIN
ILIL2613021Medicare PIN