Provider Demographics
NPI:1811219017
Name:MULLAPUDI MEDICAL LLC
Entity Type:Organization
Organization Name:MULLAPUDI MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLAPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:630-926-5409
Mailing Address - Street 1:2 SOUTH 607 AVE VENDOME
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1073
Mailing Address - Country:US
Mailing Address - Phone:630-926-5409
Mailing Address - Fax:
Practice Address - Street 1:2S607 AVENUE VENDOME
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1073
Practice Address - Country:US
Practice Address - Phone:630-926-5409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119143208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty