Provider Demographics
NPI:1790879823
Name:DONEPUDI, RADHIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:DONEPUDI
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 1:5770 KUGLER MILL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2040
Mailing Address - Country:US
Mailing Address - Phone:513-671-2902
Mailing Address - Fax:513-671-2933
Practice Address - Street 1:140 WEST KEMPER RD
Practice Address - Street 2:PHYSICIAN ASSOCIATES OF KEMPER, INC.
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2530
Practice Address - Country:US
Practice Address - Phone:513-671-2902
Practice Address - Fax:513-671-2933
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071677D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH299576OtherAMERIGROUP
OH3790099OtherAETNA
OH113742012027OtherCARE SOURCE
OH000000357567OtherANTHEM
OH2103048Medicaid
OH9352641Medicare ID - Type UnspecifiedPIN#DO0862083
OH2103048Medicaid