Provider Demographics
NPI:1235255894
Name:KALEPU, SUDHEERA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHEERA
Middle Name:
Last Name:KALEPU
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 1:429 MEDWAY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3724
Mailing Address - Country:US
Mailing Address - Phone:440-785-1594
Mailing Address - Fax:440-646-0660
Practice Address - Street 1:6751 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3903
Practice Address - Country:US
Practice Address - Phone:330-296-3641
Practice Address - Fax:330-296-5297
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherVA ID NUMBER
KS04-31798OtherKANSAS STATE LICENCE NUMB