Provider Demographics
NPI:1518158427
Name:DUDDEMPUDI, SUSHIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:
Last Name:DUDDEMPUDI
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:PO BOX 10597
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1597
Mailing Address - Country:US
Mailing Address - Phone:512-485-5889
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:7200 WYOMING SPRINGS DR STE 1300
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4306
Practice Address - Country:US
Practice Address - Phone:512-244-2273
Practice Address - Fax:512-244-3179
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1309207RG0100X
NY236703207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204471104Medicaid
TX204471103Medicaid