Provider Demographics
NPI:1225096209
Name:SUBRAMANYAM, KERALAPURA PADMINI (MD)
Entity Type:Individual
Prefix:DR
First Name:KERALAPURA
Middle Name:PADMINI
Last Name:SUBRAMANYAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2517 SUN REEF RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6880
Mailing Address - Country:US
Mailing Address - Phone:702-363-5392
Mailing Address - Fax:702-233-5860
Practice Address - Street 1:4331 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3407
Practice Address - Country:US
Practice Address - Phone:702-383-3800
Practice Address - Fax:702-395-9511
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVNV6696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF67545Medicare UPIN