SRINIVAS DONTINENI MD PA
Ambulatory Health at Wickham Rd, Melbourne, FL

License number
Florida ME 88036
Category
Ambulatory Health
Type
Primary Care
Owner
Name: DR. SRINIVAS RAO DONTINENI MD
Title: INTERNAL MEDICINE PHYSICIAN
Phone: (321) 751-9506
Address
Address 2
6550 N Wickham Rd SUITE 2, Melbourne, FL 32940
PO Box 560059, Viera, FL 32956
National Provider ID: 1639323041
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about SRINIVAS DONTINENI MD PA at bizstanding.com

SRINIVAS DONTINENI, MD, PA

1264 Malabar Rd, Palm Bay, FL 32907

Status:
Inactive
Inactive reason:
AMENDMENT
Registration:
Jul 21, 2008
Inactive since:
Dec 11, 2008
State ID:
P08000068688
Business type:
Florida Profit Corporation
Srinivas R Dontineni, 6047 Indigo Xing Dr, Rockledge, FL 32955 (Physical)
Agent:
Srinivas Dontineni,6047 Indigo Xing Dr, Rockledge, FL 32955 (Physical)
FEI/EIN:
90-0403142

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