Provider Demographics
NPI:1487844908
Name:PODDUTOORI, PADMA (MD)
Entity Type:Individual
Prefix:
First Name:PADMA
Middle Name:
Last Name:PODDUTOORI
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:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - Street 2:3901 RAINBOW BLVD, 4070 DELP, MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-2500
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD # MS 1020
Practice Address - Street 2:KU MEDICAL CENTER DIV OF GENERAL & GERIATRIC MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6005
Practice Address - Fax:913-588-3877
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104917207R00000X
KS04-34698208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146 L JOtherBCBS
FL001940800Medicaid
FL001940800Medicaid