Healthcare Provider Details

I. General information

NPI: 1043448103
Provider Name (Legal Business Name): VENU KUDITHIPUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ 7 WEST
FLINT MI
48503
US

IV. Provider business mailing address

7026 OLD KATY RD STE 276
HOUSTON TX
77024-2187
US

V. Phone/Fax

Practice location:
  • Phone: 810-232-7000
  • Fax: 810-232-7020
Mailing address:
  • Phone: 713-621-7436
  • Fax: 281-674-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31.126652
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR5584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: