MEDICARE: ANURADHA R MULPURI 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	207R00000X	Internal Medicine Physician	01054671A	IN
2	207R00000X	Internal Medicine Physician	4301093380	MI
3	207R00000X	Internal Medicine Physician	35-125104	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M59880022	OTHER	MI	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1639147655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANURADHA R MULPURI MD

Provider Business Mailing Address
First Line	:	2150 MARBLE CLIFF OFFICE PARK
Second Line	:	SUITE250
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1922
Country	:	US
Telephone Number	:	614-487-0210
Fax Number	:	614-487-0271

Provider Business Practice Location Address
First Line	:	2150 MARBLE CLIFF OFFICE PARK
Second Line	:	SUITE250
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1922
Country	:	US
Telephone Number	:	614-487-0210
Fax Number	:	614-487-0271

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	12/22/2015

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