Provider Demographics
NPI:1922100346
Name:VEMURI, KOTESWARARAO (MD)
Entity type:Individual
Prefix:
First Name:KOTESWARARAO
Middle Name:
Last Name:VEMURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 58TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6325
Mailing Address - Country:US
Mailing Address - Phone:727-820-7778
Mailing Address - Fax:727-820-7779
Practice Address - Street 1:960 58TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6325
Practice Address - Country:US
Practice Address - Phone:727-820-7778
Practice Address - Fax:727-820-7779
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071367207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI04684638Medicaid
MI04684638Medicaid
MI0N83380003Medicare PIN