Provider Demographics
NPI:1093808842
Name:RAJESH ATLURI, MD
Entity Type:Organization
Organization Name:RAJESH ATLURI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JO
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LABRIE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:940-689-8900
Mailing Address - Street 1:1619 MIDWESTERN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302
Mailing Address - Country:US
Mailing Address - Phone:940-689-8900
Mailing Address - Fax:940-689-8901
Practice Address - Street 1:1619 MIDWESTERN PARKWAY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302
Practice Address - Country:US
Practice Address - Phone:940-689-8900
Practice Address - Fax:940-689-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6804207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00422QMedicare PIN
TXG44902Medicare UPIN