Provider Demographics
NPI:1215022868
Name:YENUMULA, SUDHA RANI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHA
Middle Name:RANI
Last Name:YENUMULA
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 1:6600 BRUCEVILLE RD
Mailing Address - Street 2:334
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-4671
Mailing Address - Country:US
Mailing Address - Phone:517-977-8960
Mailing Address - Fax:916-627-7414
Practice Address - Street 1:6600 BRUCEVILLE RD
Practice Address - Street 2:334
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4671
Practice Address - Country:US
Practice Address - Phone:517-977-8960
Practice Address - Fax:916-627-7414
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0803313282OtherBCBS INDIVIDUAL PIN #
MI4922720Medicaid
MI200000002869OtherPHP PIN #
MI4922758Medicaid
MI4922776Medicaid
MI200000002870OtherPHP PIN #
MI200000002868OtherPHP PIN #
MIM77160010Medicare PIN
MII60717Medicare UPIN
MI4922720Medicaid
MIC36091052Medicare PIN