=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376538827
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MITTUR NANJAPPA RAMPRASAD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2005
-----------------------------------------------------
Last Update Date | 12/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 NW ATLANTIC ST
-----------------------------------------------------
City | TULLAHOMA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37388-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-455-6720
-----------------------------------------------------
Fax | 931-393-2837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 NW ATLANTIC ST
-----------------------------------------------------
City | TULLAHOMA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37388-3504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-455-6720
-----------------------------------------------------
Fax | 931-393-2837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | MD0000013749
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------