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1891780326

NPI Code Detail

MEDICARE: SHIVAPRAKASH T KUDLAPUR MD

MEDICARE: SHIVAPRAKASH T KUDLAPUR 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	35065974K	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00084899	OTHER		RAILROAD MEDICARE

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
2	311155352	OTHER		E V BENEFITS
3	311155352	OTHER	OH	OHIO HEALTH CHOICE
4	311155352	OTHER		AETNA
6	0408409	OTHER		UNITED HEALTHCARE
7	311155352	OTHER		CIGNA/CONN GENERAL
8	311155352	OTHER		PPO NEXT
9	311155352	OTHER		TRICARE
10	311155352	OTHER		CENTRAL BENEFITS
11	000000300069	OTHER	OH	ANTHEM
12	311155352	OTHER		EMERALD HEALTH
13	311155352	OTHER		GREAT WEST

General Provider Information

NPI Number	:	1891780326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVAPRAKASH T KUDLAPUR MD

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-0188
Country	:	US
Telephone Number	:	740-773-4366
Fax Number	:	740-775-7855

Provider Business Practice Location Address
First Line	:	30381 CHIEFTAIN DR
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-9092
Country	:	US
Telephone Number	:	740-385-2555
Fax Number	:	740-380-3750

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	11/06/2019

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Directions to “ SHIVAPRAKASH T KUDLAPUR MD” Practice Location

Language	Start Address	Practice Location

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