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NPI Code Detail

MEDICARE: DR. SUDHEERA KALEPU M.D.

MEDICARE: DR. SUDHEERA KALEPU M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician04-31798KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1VAD000OTHERVA ID NUMBER
204-31798OTHERKSKANSAS STATE LICENCE NUMB

General Provider Information

NPI Number : 1235255894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUDHEERA KALEPU M.D.
Provider Business Mailing Address
First Line : 429 MEDWAY RD
Second Line :
City : HIGHLAND HEIGHTS
State : OH
Zip : 44143-3724
Country : US
Telephone Number : 440-785-1594
Fax Number : 440-646-0660
Provider Business Practice Location Address
First Line : 6751 N CHESTNUT ST
Second Line :
City : RAVENNA
State : OH
Zip : 44266-3903
Country : US
Telephone Number : 330-296-3641
Fax Number : 330-296-5297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 07/08/2007

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