Provider Demographics
NPI:1639147655
Name:MULPURI, ANURADHA R (MD)
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:R
Last Name:MULPURI
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 1:2150 MARBLE CLIFF OFFICE PARK
Mailing Address - Street 2:SUITE250
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1922
Mailing Address - Country:US
Mailing Address - Phone:614-487-0210
Mailing Address - Fax:614-487-0271
Practice Address - Street 1:2150 MARBLE CLIFF OFFICE PARK
Practice Address - Street 2:SUITE250
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1922
Practice Address - Country:US
Practice Address - Phone:614-487-0210
Practice Address - Fax:614-487-0271
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054671A207R00000X
MI4301093380207R00000X
OH35-125104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM59880022OtherMEDICARE PTAN
MI1639147655Medicaid
IN200338630AMedicaid
MIM59880022OtherMEDICARE PTAN