Provider Demographics
NPI:1073731683
Name:GUDIPATY, MADHURI (MD)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:GUDIPATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 COIT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6174
Mailing Address - Country:US
Mailing Address - Phone:972-867-7500
Mailing Address - Fax:972-578-7550
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:972-867-7500
Practice Address - Fax:972-578-7550
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E012740OtherBCBS
MI0N40170OtherMEDICARE GROUP NUMBER
MI700E012740OtherBCBS GROUP NUMBER
MI16-0636544-2OtherBCBS PIN NUMBER