Provider Demographics
NPI:1003256900
Name:KUKKADAPU, TARUN (MBBS)
Entity Type:Individual
Prefix:
First Name:TARUN
Middle Name:
Last Name:KUKKADAPU
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-5864
Mailing Address - Fax:256-265-5865
Practice Address - Street 1:1104 MONROE ST SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5029
Practice Address - Country:US
Practice Address - Phone:256-265-5864
Practice Address - Fax:256-265-5865
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38521207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease