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General NPI Number Information
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NPI Number | 1700033032
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Entity Type | Individual
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Provider Name | MADAN MOHAN REDDY KOPPOLU M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 309 JACKSON ST
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City | MONROE
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State | LA
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Zip | 71201-7407
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Country | US
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Telephone | 318-966-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 8312 MISTY CREEK DR
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City | GERMANTOWN
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State | TN
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Zip | 38138-7604
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Country | US
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Telephone | 520-906-7591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD204817
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 51854
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License Number State | TN
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