Provider Demographics
NPI:1487672564
Name:BANDLAMURI, SUREKHA (MD)
Entity Type:Individual
Prefix:
First Name:SUREKHA
Middle Name:
Last Name:BANDLAMURI
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 1:395 N. SILVERBELL RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:520-622-7675
Mailing Address - Fax:520-628-1024
Practice Address - Street 1:395 N. SILVERBELL RD
Practice Address - Street 2:SUITE 245
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745
Practice Address - Country:US
Practice Address - Phone:520-622-7675
Practice Address - Fax:520-628-1024
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31764207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221248Medicaid
AZ221248Medicaid
AZH90390Medicare UPIN