Provider Demographics
NPI:1518962133
Name:MULPURI, RAGHU (MD)
Entity Type:Individual
Prefix:
First Name:RAGHU
Middle Name:
Last Name:MULPURI
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 1:625 PERRIEN PL
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1132
Mailing Address - Country:US
Mailing Address - Phone:248-265-4080
Mailing Address - Fax:248-265-4082
Practice Address - Street 1:27450 SCHOENHERR RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6683
Practice Address - Country:US
Practice Address - Phone:586-582-7632
Practice Address - Fax:586-582-7633
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061786207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76181Medicare UPIN
MI0P29620Medicare ID - Type Unspecified
MI4841598Medicaid
G76181Medicare UPIN