Healthcare Provider Details

I. General information

NPI: 1114227733
Provider Name (Legal Business Name): SUDHAKAR NADIPALLY M.B.B.S.,M.P.H.,M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 S MADERA AVE KERMAN HEALTH CENTER VALLEY HEALTH TEAM
KERMAN CA
93630-1537
US

IV. Provider business mailing address

449 S MADERA AVE KERMAN HEALTH CENTER VALLEY HEALTH TEAM
KERMAN CA
93630-1537
US

V. Phone/Fax

Practice location:
  • Phone: 208-540-1070
  • Fax:
Mailing address:
  • Phone: 208-540-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA116136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: