Provider Demographics
NPI:1942260468
Name:KODALI, MURALI KRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MURALI KRISHNA
Middle Name:
Last Name:KODALI
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 1:2946 E BANNER GATEWAY DR.
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-256-3223
Mailing Address - Fax:480-256-4003
Practice Address - Street 1:625 N 6TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-406-8222
Practice Address - Fax:602-406-4500
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49958207R00000X, 207RH0003X
FLME 101276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2814072-00Medicaid
41726OtherBLUE CROSS BLUE SHIELD
NM997033219Medicaid
NM343530802Medicare ID - Type Unspecified
NM997033219Medicaid
FL2814072-00Medicaid
41726OtherBLUE CROSS BLUE SHIELD