Provider Demographics
NPI:1376538827
Name:RAMPRASAD, MITTUR NANJAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:MITTUR
Middle Name:NANJAPPA
Last Name:RAMPRASAD
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 1:509 NW ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3504
Mailing Address - Country:US
Mailing Address - Phone:931-455-6720
Mailing Address - Fax:931-393-2837
Practice Address - Street 1:509 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3504
Practice Address - Country:US
Practice Address - Phone:931-455-6720
Practice Address - Fax:931-393-2837
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000013749207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0113OtherAM CHOICE
TN31890561Medicaid
TN3189056Medicaid
TN4142496OtherBLUE CROSS
TN0016097OtherBCBST
TN31890561Medicaid
TNTN0113OtherAM CHOICE
TN3189056Medicaid