Provider Demographics
NPI:1083673453
Name:VALLURUPALLI, PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:PRASAD
Middle Name:
Last Name:VALLURUPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 N STEMMONS FWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4231
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:4521 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 500
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1651
Practice Address - Country:US
Practice Address - Phone:972-562-8383
Practice Address - Fax:972-548-8388
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6420207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131641605Medicaid
TX84Y124OtherBCBSTX
TX131641605Medicaid
TX84Y124Medicare PIN
TX100012393Medicare PIN