Healthcare Provider Details

I. General information

NPI: 1295700979
Provider Name (Legal Business Name): RAMA KUCHIPUDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

2520 NE 12TH ST
POMPANO BEACH FL
33062-3712
US

V. Phone/Fax

Practice location:
  • Phone: 305-930-2208
  • Fax:
Mailing address:
  • Phone: 305-930-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number319929
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2310
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME153668
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036108254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: