Provider Demographics
NPI:1326031006
Name:AKKULUGARI, SHYAM K (MD, MPH)
Entity Type:Individual
Prefix:MR
First Name:SHYAM
Middle Name:K
Last Name:AKKULUGARI
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:PO BOX 7612
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-0612
Mailing Address - Country:US
Mailing Address - Phone:913-271-8676
Mailing Address - Fax:888-856-3199
Practice Address - Street 1:14540 SWITZER RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-9748
Practice Address - Country:US
Practice Address - Phone:913-271-8676
Practice Address - Fax:888-856-3199
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA35929207P00000X, 207Q00000X, 207QG0300X, 207QH0002X
MO2006018690207P00000X, 207QG0300X, 207QH0002X, 207Q00000X
KS0434165207P00000X, 207Q00000X, 207QG0300X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOI29925Medicare UPIN