Provider Demographics
NPI:1942252762
Name:KODURI, SUMANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMANA
Middle Name:
Last Name:KODURI
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 1:18200 W CAPITOL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-1446
Mailing Address - Country:US
Mailing Address - Phone:262-444-5148
Mailing Address - Fax:262-444-5457
Practice Address - Street 1:18200 W CAPITOL DR STE 200
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-1446
Practice Address - Country:US
Practice Address - Phone:262-444-5148
Practice Address - Fax:262-444-5457
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI369752088F0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942252762Medicaid
WI1942252762Medicaid
G81619Medicare UPIN
WI018T0712Medicare PIN