Provider Demographics
NPI:1083660518
Name:PAVULURI, RAMESH (DPM)
Entity Type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:PAVULURI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SKYLINE CIR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2561
Mailing Address - Country:US
Mailing Address - Phone:615-441-0002
Mailing Address - Fax:615-446-2827
Practice Address - Street 1:214 SKYLINE CIR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2561
Practice Address - Country:US
Practice Address - Phone:615-441-0002
Practice Address - Fax:615-446-2827
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM406213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3351868Medicare ID - Type Unspecified
U18696Medicare UPIN