Healthcare Provider Details

I. General information

NPI: 1447412788
Provider Name (Legal Business Name): SANTARAM VALLURUPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 STANTON L YOUNG BLVD SUITE WP 1380
OKLAHOMA CITY OK
73104-5036
US

IV. Provider business mailing address

920 STANTON L YOUNG BLVD SUITE WP 1380
OKLAHOMA CITY OK
73104-5036
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4426
  • Fax: 405-271-3074
Mailing address:
  • Phone: 405-271-4426
  • Fax: 405-271-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2008015178
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number121194
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number30833
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: