Provider Demographics
NPI:1508022344
Name:MADDUKURI, GEETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETHA
Middle Name:
Last Name:MADDUKURI
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 1:1231 TWINLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7875
Mailing Address - Country:US
Mailing Address - Phone:636-697-5415
Mailing Address - Fax:
Practice Address - Street 1:1231 TWIN LEAF CIRCLE
Practice Address - Street 2:
Practice Address - City:ST.PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-697-5415
Practice Address - Fax:636-697-5415
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine