1285742296 NPI number — SURESH KUNAPAREDDY M.D.

Table of content: SURESH KUNAPAREDDY M.D. (NPI 1285742296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285742296 NPI number — SURESH KUNAPAREDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUNAPAREDDY
Provider First Name:
SURESH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285742296
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 S 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47807-4214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-242-3610
Provider Business Mailing Address Fax Number:
812-242-3630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1711 N 6 1/2 ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47804-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-242-3610
Provider Business Practice Location Address Fax Number:
812-242-3630
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  01054210A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000194279 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 900003738 . This is a "RAILROAD MCARE PALAMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00818718 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200333390 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200333390Y , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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