MEDICARE: SUPRAJA THUNUGUNTLA

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	207RC0001X	Clinical Cardiac Electrophysiology Physician	173110	MT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1467957324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUPRAJA THUNUGUNTLA

Provider Business Mailing Address
First Line	:	PO BOX 6010
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59406-6010
Country	:	US
Telephone Number	:	406-731-8817
Fax Number	:	406-731-8318

Provider Business Practice Location Address
First Line	:	1300 28TH ST S FL 2
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-5296
Country	:	US
Telephone Number	:	406-455-4320
Fax Number	:	406-731-8318

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

Provider Enumeration Date	:	03/24/2018
Last Update Date	:	06/17/2026

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Directions to “ SUPRAJA THUNUGUNTLA ” Practice Location

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