Provider Demographics
NPI:1972528792
Name:MUPPIDI, MADHAVI R (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:R
Last Name:MUPPIDI
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:PO BOX 678641
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8641
Mailing Address - Country:US
Mailing Address - Phone:214-346-1313
Mailing Address - Fax:817-284-3425
Practice Address - Street 1:11409 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6678
Practice Address - Country:US
Practice Address - Phone:214-363-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22554208100000X
TXL5064208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196316701Medicaid
OK100035370AMedicaid
TX8L12455Medicare PIN
H23700Medicare UPIN
TX196316701Medicaid
OK$$$$$$$$$Medicare PIN
TX8F7064Medicare PIN