Provider Demographics
NPI:1679246813
Name:EDUPUGANTI, SRUJAN (MBBS)
Entity Type:Individual
Prefix:
First Name:SRUJAN
Middle Name:
Last Name:EDUPUGANTI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HURLEY PLAZA, 6W PEDS EDUCATION
Mailing Address - Street 2:HURLEY MEDICAL CENTER
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-262-9000
Mailing Address - Fax:810-262-9736
Practice Address - Street 1:1 HURLEY PLAZA
Practice Address - Street 2:PEDIATRIC EDUCATION 6W
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-262-7045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program