Provider Demographics
NPI:1184622078
Name:PUCHALAPALLI, SUBBAREDDY (MD)
Entity type:Individual
Prefix:DR
First Name:SUBBAREDDY
Middle Name:
Last Name:PUCHALAPALLI
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 1:2250 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-3317
Mailing Address - Country:US
Mailing Address - Phone:812-232-3225
Mailing Address - Fax:812-232-4215
Practice Address - Street 1:2250 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3317
Practice Address - Country:US
Practice Address - Phone:812-232-3225
Practice Address - Fax:812-232-4215
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046393A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200148980CMedicaid
IN200148980CMedicaid
ING32388Medicare UPIN