Provider Demographics
NPI:1679541445
Name:MADASU, RAM KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAM
Middle Name:KUMAR
Last Name:MADASU
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 1:5511 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4646
Mailing Address - Country:US
Mailing Address - Phone:954-755-4002
Mailing Address - Fax:954-755-5010
Practice Address - Street 1:5511 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101B
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4646
Practice Address - Country:US
Practice Address - Phone:954-755-4002
Practice Address - Fax:954-755-5010
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85117207Y00000X, 207YP0228X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51399AOtherPIN NUMBER
FLK3850Medicare ID - Type UnspecifiedMEDICARE
FL51399AOtherPIN NUMBER