MEDICARE: TUCSON INPATIENT MEDICINE PLLC

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	207R00000X	Internal Medicine Physician	30466	AZ

General Provider Information

NPI Number	:	1235108184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON INPATIENT MEDICINE PLLC

Provider Business Mailing Address
First Line	:	6556 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2117
Country	:	US
Telephone Number	:	520-296-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	6556 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2117
Country	:	US
Telephone Number	:	520-296-8733
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAM SUBBUREDDIAR
Credential	:	MD
Telephone Number	:	520-297-8733

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/22/2008

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