Provider Demographics
NPI:1669460853
Name:MULPURI, RAJ KISHORE (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:KISHORE
Last Name:MULPURI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13634 N 93RD AVE
Mailing Address - Street 2:#100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:623-933-0301
Mailing Address - Fax:623-933-0224
Practice Address - Street 1:18731 N REEMS RD
Practice Address - Street 2:#680
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-975-0592
Practice Address - Fax:623-675-0750
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
AZ32853207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ874455-01Medicaid
AZ874455Medicaid
AZ874455Medicaid
G84303Medicare UPIN
AZ874455-01Medicaid