MEDICARE: MR. MURTY S VUPPALA

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	208000000X	Pediatrics Physician	35042888	OH

General Provider Information

NPI Number	:	1811061542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MURTY S VUPPALA

Provider Business Mailing Address
First Line	:	6363 YORK ROAD
Second Line	:	SUITE 103
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3031
Country	:	US
Telephone Number	:	440-888-1500
Fax Number	:	440-888-5809

Provider Business Practice Location Address
First Line	:	6363 YORK ROAD
Second Line	:	SUITE 103
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-3031
Country	:	US
Telephone Number	:	440-888-1500
Fax Number	:	440-888-5809

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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