MEDICARE: SARAT K DONEPUDI MD APMC

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	261QP2300X	Primary Care Clinic/Center	04727R	LA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417134735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAT K DONEPUDI MD APMC

Provider Business Mailing Address
First Line	:	21420 HIGHWAY 20 WEST
Second Line	:
City	:	VACHERIE
State	:	LA
Zip	:	70090-3614
Country	:	US
Telephone Number	:	225-265-3013
Fax Number	:	225-265-3775

Provider Business Practice Location Address
First Line	:	21420 HIGHWAY 20
Second Line	:
City	:	VACHERIE
State	:	LA
Zip	:	70090-3614
Country	:	US
Telephone Number	:	225-265-3013
Fax Number	:	225-265-3775

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SARAT K DONEPUDI
Credential	:	M.D.
Telephone Number	:	225-265-3013

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	08/15/2008

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