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General NPI Number Information
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NPI Number | 1346554169
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Entity Type | Organization
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Legal Business Name | PUCHALAPALLI M D, INC.
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 2250 WABASH AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47807-3317
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Country | US
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Telephone | 812-232-3225
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Fax | 812-232-4215
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Provider Business Mailing Address
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Address Line | 2250 WABASH AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47807-3317
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Country | US
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Telephone | 812-232-3225
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Fax | 812-232-4215
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Authorized Official
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Title or Position | OWNER
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Name | SUBBAREDDY PUCHALAPALLI
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Credential | MD
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Telephone | 812-232-3225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01046393A
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License Number State | IN
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