Provider Demographics
NPI:1831281542
Name:PASUPULETI, DEVAKINANDA V (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVAKINANDA
Middle Name:V
Last Name:PASUPULETI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5424
Mailing Address - Country:US
Mailing Address - Phone:810-230-7770
Mailing Address - Fax:810-230-0639
Practice Address - Street 1:2370 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5424
Practice Address - Country:US
Practice Address - Phone:810-230-7770
Practice Address - Fax:810-230-0639
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDP052810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43331Medicare UPIN