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NPI Code Detail

MEDICARE: DR. SANDEEPA MUSUNURU M.D.

MEDICARE: DR. SANDEEPA MUSUNURU M.D.
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
1208600000XSurgery PhysicianP0260TX
22086S0127XTrauma Surgery PhysicianP0260TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2TXB140254OTHERTXMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18CW789OTHERTXBLUE CROSS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710942917
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDEEPA MUSUNURU M.D.
Provider Business Mailing Address
First Line : 2405 W MISSOURI AVE
Second Line :
City : MIDLAND
State : TX
Zip : 79701-6800
Country : US
Telephone Number : 432-697-1061
Fax Number : 432-697-7089
Provider Business Practice Location Address
First Line : 2405 W MISSOURI AVE
Second Line :
City : MIDLAND
State : TX
Zip : 79701-6800
Country : US
Telephone Number : 432-697-1061
Fax Number : 432-697-7089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 04/15/2015

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