Healthcare Provider Details

I. General information

NPI: 1386908721
Provider Name (Legal Business Name): VINAY KRISHNA PULUSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

4600 N CLARENDON AVE 512
CHICAGO IL
60640-5710
US

V. Phone/Fax

Practice location:
  • Phone: 412-802-3043
  • Fax:
Mailing address:
  • Phone: 940-447-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125060740
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code246ZN0300X
TaxonomyNephrology Specialist/Technologist
License NumberMT233257
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: