MEDICARE: DR. NAGESHWARA R. GULLAPALLI MBBS, MPH, MBA

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	11168	NV
2	207RC0000X	Cardiovascular Disease Physician	12772344-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295708451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAGESHWARA R. GULLAPALLI MBBS, MPH, MBA

Provider Business Mailing Address
First Line	:	30 N 1900 E RM 4A100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-587-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N 1900 E RM 4A100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-587-2451
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	04/07/2022

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