Provider Demographics
NPI:1225038862
Name:MUNDLURU, ANURADHA LEKKALA (MD)
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:LEKKALA
Last Name:MUNDLURU
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 1:929 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2476
Mailing Address - Country:US
Mailing Address - Phone:972-216-0079
Mailing Address - Fax:
Practice Address - Street 1:929 N GALLOWAY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7414
Practice Address - Country:US
Practice Address - Phone:972-216-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56257Medicare UPIN
TX0049CAMedicare PIN