Provider Demographics
NPI:1184660938
Name:HINDUPUR, MOHAN R (MD)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:R
Last Name:HINDUPUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5514 CORPORATE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7763
Mailing Address - Country:US
Mailing Address - Phone:816-271-1265
Mailing Address - Fax:816-271-4062
Practice Address - Street 1:5514 CORPORATE DR STE 150
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-7752
Practice Address - Country:US
Practice Address - Phone:816-271-1291
Practice Address - Fax:816-271-4062
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7G44207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202458303Medicaid
KS100207430BMedicaid
MO202458303Medicaid
MOC43799Medicare UPIN