Provider Demographics
NPI:1043363260
Name:MURALI DAVULURI MD APMC
Entity Type:Organization
Organization Name:MURALI DAVULURI MD APMC
Other - Org Name:DAVULURI CHILDREN'S CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURALI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVULURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD FANP MB BS
Authorized Official - Phone:985-868-7500
Mailing Address - Street 1:1020 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5756
Mailing Address - Country:US
Mailing Address - Phone:985-868-7500
Mailing Address - Fax:985-223-6300
Practice Address - Street 1:1020 LEE AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5756
Practice Address - Country:US
Practice Address - Phone:985-868-7500
Practice Address - Fax:985-223-6300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MURALI DAVULURI MD A PROFESSIONAL MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06662R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1368750Medicaid
LA426378542COtherBCBS OF LA
LA1368750Medicaid