DR. MALLIK A PIDURU (NPI# 1265405997) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265405997 |
| Entity Type | Individual |
| Full Name | DR. MALLIK A PIDURU |
| Credential | M.D. |
| Practice Address |
11373 Cortez Blvd Suite 201 Brooksville FL 34613-5414 |
| Mailing Address |
15215 Cortez Blvd Brooksville FL 34613-6072 |
| Practice Telephone | 3525967860 |
| Practice Fax Number | 3525973657 |
| Mailing Telephone | 3527990046 |
| Mailing Fax Number | 7278611881 |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2012-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | ME0044053 | FL | Allopathic & Osteopathic Physicians |
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
ME0044053 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 036160700 | 05 | |
| FL | RR MCR ATTACHED TO GRP# CH7269 | P00867800 | 01 |
| FL | WELLCARE | 165252 | 01 |
| FL | BCBS | 26064 | 01 |
| FL | RR MCR | P00984624 | 01 |
| Street Address |
11373 CORTEZ BLVD SUITE 201 |
| City | BROOKSVILLE |
| State | FL |
| Zip Code | 34613-5414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356348064 | Steven Harding Moss | Orthopaedic Surgery | 11373 Cortez Blvd, Suite 301, Brooksville, FL 34613-5414 | 2005-07-07 |
| 1427547819 | Kevin Chao Hong | Student in an Organized Health Care Education/Training Program | 11373 Cortez Blvd, Brooksville, FL 34613-5414 | 2018-05-01 |
| 1255729638 | Pine Brook Pharmacy LLC | Pharmacy | 11373 Cortez Blvd, Suite 101, Brooksville, FL 34613-5414 | 2015-01-07 |
| 1265853402 | Ocala Oncology Center Pl | Urology | 11373 Cortez Blvd, Suite 405, Brooksville, FL 34613-5406 | 2013-12-13 |
| 1467873638 | Ocala Oncology Center Pl | Urology | 11373 Cortez Blvd, Suite 209, Brooksville, FL 34613-5414 | 2013-12-13 |
| 1639510829 | Ocala Oncology Center Pl | Internal Medicine | 11373 Cortez Blvd, Suite 200, Brooksville, FL 34613-5405 | 2013-07-16 |
| 1861735888 | Aaron Cleveland Denson | Internal Medicine | 11373 Cortez Blvd, Suite 200, Brooksville, FL 34613 | 2013-03-27 |
| 1326390501 | Access Health Care Physicians LLC | Clinic/Center | 11373 Cortez Blvd, 304, Brooksville, FL 34613-5414 | 2012-10-11 |
| 1790054872 | Florida Cancer Affiliates Pl | Radiology | 11373 Cortez Blvd, Suite 200, Brooksville, FL 34613-5414 | 2011-12-20 |
| 1215224126 | Oleg Gligich | Internal Medicine | 11373 Cortez Blvd, Suite 200, Brooksville, FL 34613 | 2011-06-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679196836 | Izza Bazigh | Student in an Organized Health Care Education/Training Program | 11375 Cortez Boulevard, Sr 50, Office of Graduate Medic, Brooksville, FL 34613 | 2020-05-22 |
| 1003446824 | Spring Hill Pediatric Dentistry, LLC | Dentist | 7140 Sagheer St., Brooksville, FL 34613 | 2020-01-21 |
| 1407405822 | Medical Risk Solutions | Family Medicine | 12080 Cortez Blvd, Brooksville, FL 34613 | 2019-09-09 |
| 1528529245 | Edward Joseph Waseleski Jr. | Student in an Organized Health Care Education/Training Program | 11375 Cortez Blvd., State Road 50, Brooksville, FL 34613 | 2019-03-26 |
| 1366903213 | Paresh Rangani | Student in an Organized Health Care Education/Training Program | 11375 Cortez Blvd., State Road 50, Brooksville, FL 34613 | 2019-03-25 |
| 1225558034 | Whitney King | Student in an Organized Health Care Education/Training Program | 11375 Cortez Boulevard, State Road 50, Brooksville, FL 34613 | 2017-06-22 |
| 1922450022 | Visionworks, Inc | Eyewear Supplier (Equipment, not the service) | 13217 Cortez Rd, Brooksville, FL 34613 | 2016-07-13 |
| 1992157408 | Arushi Goel | Internal Medicine | 11375 Cortez Boulevard, Oak Hill Hospital, Brooksville, FL 34613 | 2016-07-08 |
| 1366823122 | Monicka Stella Felix | Internal Medicine | 11375 Cortez Boulevard, Sr 50, Oak Hill Hospital, Gme Attn: Melissa Tammaro, Brooksville, FL 34613 | 2015-06-17 |
| 1790171700 | April Greer | Hearing Instrument Specialist | 13013 Cortez Blvd., Brooksville, FL 34613 | 2015-04-07 |
| Find all providers in zip 34613 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295767986 | Xavier M. Jenkins | Surgery | 11315 Cortez Blvd, Brooksville, FL 34613 | 2006-07-06 |
| 1770541021 | George T Tsai | Surgery | 17222 Hospital Blvd Ste 326, Brooksville, FL 34601-8906 | 2006-05-03 |
| 1063473817 | Central Hernando Surgical Associates P A | Surgery | 11333 Cortez Blvd, Brooksville, FL 34613-6311 | 2006-03-31 |
| 1407822422 | Mit Navanit Desai | Surgery | 17222 Hospital Blvd Ste 116, Brooksville, FL 34601-8925 | 2006-02-28 |
| 1801885611 | Steven A. Visnaw | Surgery | 11373 Cortez Bvld, Suite 202, Brooksville, FL 34613 | 2005-10-14 |
| 1558359802 | Fawzi Soliman Md Pa | Surgery | 12132 Cortez Blvd, Brooksville, FL 34613-5575 | 2005-10-11 |
| 1073510772 | Frederick D Cason Jr. | Surgery | 11373 Cortez Blvd Ste 208, Brooksville, FL 34613-5405 | 2005-07-07 |
| 1487048930 | Kelly Elleson | Surgery | 11373 Cortez Blvd Ste 208, Brooksville, FL 34613-5405 | 2015-03-23 |
| 1710281340 | Hussam Ismael | Surgery | 17222 Hospital Blvd, Suite 326, Brooksville, FL 34601-8925 | 2010-12-21 |
| 1750570792 | Steven A Visnaw Do Pa | Surgery | 11373 Cortez Blvd, Suite 202, Brooksville, FL 34613-5414 | 2007-10-16 |
| Find all providers in BROOKSVILLE | ||||
| City | BROOKSVILLE |
| Zip Code | 34613 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.