Provider Demographics
NPI:1366439697
Name:MULPURI, RAMA C (MD)
Entity Type:Individual
Prefix:
First Name:RAMA
Middle Name:C
Last Name:MULPURI
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 1:801 JOE MANN BLVD STE P-6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8900
Mailing Address - Country:US
Mailing Address - Phone:989-791-2455
Mailing Address - Fax:989-791-1392
Practice Address - Street 1:4705 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2818
Practice Address - Country:US
Practice Address - Phone:989-799-6130
Practice Address - Fax:989-799-6146
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI065512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0G30512OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0731188OtherBCBS ID NUMBER
MI4833943Medicaid
MI0P26420Medicare PIN
0G30512OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4833943Medicaid