Healthcare Provider Details

I. General information

NPI: 1164669305
Provider Name (Legal Business Name): RAMI REDDY BUCHIPUDI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 TAFT BLVD APT 3301
WICHITA FALLS TX
76308-5391
US

IV. Provider business mailing address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

V. Phone/Fax

Practice location:
  • Phone: 940-232-6878
  • Fax:
Mailing address:
  • Phone: 817-820-4906
  • Fax: 817-820-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN3521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: