MEDICARE: SUDHA KUDAPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302032319	MI

General Provider Information

NPI Number	:	1215213202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUDHA KUDAPA

Provider Business Mailing Address
First Line	:	3175 JULY CT
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2838
Country	:	US
Telephone Number	:	586-997-2589
Fax Number	:

Provider Business Practice Location Address
First Line	:	4019 METROPOLITAN PKWY
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4517
Country	:	US
Telephone Number	:	586-446-8104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2011
Last Update Date	:	10/23/2011

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Directions to “ SUDHA KUDAPA ” Practice Location

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