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NPI Code Detail

MEDICARE: BALA KOTESWARA RAO DAVULURI

MEDICARE: BALA KOTESWARA RAO DAVULURI
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
12084N0400XNeurology Physician52575MN
22084N0400XNeurology Physician62281-020WI
3390200000XStudent in an Organized Health Care Education/Training Program
42084N0400XNeurology Physician01084760AIN

Other Identifiers

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

General Provider Information

NPI Number : 1407010754
Entity Type Code : Individual
Provider Name (Legal Business Name) : BALA KOTESWARA RAO DAVULURI
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 2354 WEST BOULVARD
Second Line :
City : KOKOMO
State : IN
Zip : 46902-6069
Country : US
Telephone Number : 765-457-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2008
Last Update Date : 04/15/2022

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