Provider Demographics
NPI:1265613830
Name:RAMA CHERUKURI MULPURI MD
Entity type:Organization
Organization Name:RAMA CHERUKURI MULPURI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:CHERUKURI
Authorized Official - Last Name:MULPURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-799-6130
Mailing Address - Street 1:4705 TOWNE CENTRE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2819
Mailing Address - Country:US
Mailing Address - Phone:989-799-6130
Mailing Address - Fax:989-799-6146
Practice Address - Street 1:4705 TOWNE CENTRE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2819
Practice Address - Country:US
Practice Address - Phone:989-799-6130
Practice Address - Fax:989-799-6146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAMA CHERUKURI MULPURI MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-23
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI065512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTRICARE
MIMI6644Medicare PIN
MIH02918Medicare UPIN
MI=========OtherTRICARE