Provider Demographics
NPI:1225082829
Name:INAMPUDI, SUBBARAO (MD)
Entity Type:Individual
Prefix:
First Name:SUBBARAO
Middle Name:
Last Name:INAMPUDI
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 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100708OtherUCARE
MN055800100Medicaid
MN22840OtherAMERICA'S PPO
MN300065113OtherRAILROAD MEDICARE MN
IA0532069Medicaid
MN1021802OtherPREFERRED ONE
WI300014662OtherRAILROAD MEDICARE WI
WI31778800Medicaid
MN029R4INOtherBLUE CROSS
MN72042INOtherBLUE CROSS
MNHP13586OtherHEALTHPARTNERS
WI31778800Medicaid
MN100708OtherUCARE
MN055800100Medicaid
IA0532069Medicaid