Provider Demographics
NPI:1275507378
Name:TALLURI, MURALI (MD)
Entity Type:Individual
Prefix:
First Name:MURALI
Middle Name:
Last Name:TALLURI
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 1:10631 S 51ST ST STE 8
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5225
Mailing Address - Country:US
Mailing Address - Phone:480-298-9951
Mailing Address - Fax:866-246-5494
Practice Address - Street 1:10631 S 51ST ST STE 8
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5225
Practice Address - Country:US
Practice Address - Phone:480-298-9951
Practice Address - Fax:866-246-5494
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ295239Medicaid
AZE85933Medicare UPIN
AZ295239Medicaid