MEDICARE: DR. SUDHAKAR NAIDU PANGULUR 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
1	207RG0100X	Gastroenterology Physician	35054670	OH

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

General Provider Information

NPI Number	:	1871581256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUDHAKAR NAIDU PANGULUR M.D.

Provider Business Mailing Address
First Line	:	2702 NAVARRE AVE STE 320
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3224
Country	:	US
Telephone Number	:	419-696-5555
Fax Number	:	419-696-8499

Provider Business Practice Location Address
First Line	:	2702 NAVARRE AVE STE 320
Second Line	:
City	:	OREGON
State	:	OH
Zip	:	43616-3224
Country	:	US
Telephone Number	:	419-696-5555
Fax Number	:	419-696-8499

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	06/26/2019

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