Healthcare Provider Details

I. General information

NPI: 1710409958
Provider Name (Legal Business Name): MRUDULA THIRIVEEDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 7TH ST SE
DECATUR AL
35601-3337
US

IV. Provider business mailing address

PO BOX 21007
HUNTSVILLE AL
35813-5007
US

V. Phone/Fax

Practice location:
  • Phone: 256-341-2909
  • Fax:
Mailing address:
  • Phone: 256-801-6056
  • Fax: 256-801-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41059
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD.41059
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: