Provider Demographics
NPI:1609834928
Name:DHUPATI, MADHURI (MD)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:DHUPATI
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:PO BOX 8720
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0128
Mailing Address - Country:US
Mailing Address - Phone:623-544-1700
Mailing Address - Fax:623-544-7544
Practice Address - Street 1:12647 W SMOKEY DR STE 119
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-3799
Practice Address - Country:US
Practice Address - Phone:623-544-1700
Practice Address - Fax:623-544-7544
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG6070Medicare UPIN
AZZ79873Medicare PIN