MEDICARE: SIVAPRASAD D MADDURI MD

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	208800000X	Urology Physician	R7648	MO

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	:	1447238035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIVAPRASAD D MADDURI MD

Provider Business Mailing Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 216
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-4133
Fax Number	:	573-686-1298

Provider Business Practice Location Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 216
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-4133
Fax Number	:	573-686-1298

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	10/01/2013

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Directions to “ SIVAPRASAD D MADDURI MD” Practice Location

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