| Doctor Name: | MR. MALLIKARJUNA B URMUNDALAVAUR |
| NPI Number: | 1295759868 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME75135 |
| Business Practice Address: | 4415 Us Highway 331 S Ste A Defuniak Springs, FL - 324356307 |
| Business Phone Number: | 8506825332 |
| Business Fax Number: | 8506828486 |
| Mailing Address: | 4415 Us Highway 331 S Ste A, DEFUNIAK SPRINGS |
| State: | FL |
| Postal Code: | 324356307 |
| Phone Number: | 8506825332 |
| Fax Number: | 8506828486 |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME75135 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |