Healthcare Provider Details

I. General information

NPI: 1720640253
Provider Name (Legal Business Name): ANUSHA MOPURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3267
  • Fax: 216-844-5916
Mailing address:
  • Phone: 216-844-3620
  • Fax: 216-844-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-19026
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: