Provider Demographics
NPI:1922075035
Name:DONEPUDI, SURESH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:KUMAR
Last Name:DONEPUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8921 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2144
Mailing Address - Country:US
Mailing Address - Phone:318-688-5416
Mailing Address - Fax:318-688-5823
Practice Address - Street 1:8921 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2144
Practice Address - Country:US
Practice Address - Phone:318-688-5416
Practice Address - Fax:318-688-5823
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0174792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1380181Medicaid
LA1380181Medicaid
B65655Medicare UPIN