1477048593 NPI number — DR. SAI GIRIDHAR GUNDEPALLI MBBS

Table of content: DR. SAI GIRIDHAR GUNDEPALLI MBBS (NPI 1477048593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477048593 NPI number — DR. SAI GIRIDHAR GUNDEPALLI MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNDEPALLI
Provider First Name:
SAI GIRIDHAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
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:
1477048593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7710 MERCY ROAD, CU DEPARTMENT OF INTERNAL MEDICINE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68124-2353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-280-4392
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 W 10TH AVE DEPT OF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43210-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-293-5066
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2018

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: 207R00000X , with the licence number:  8252 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35.143105 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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