Provider Demographics
NPI:1770540197
Name:KUCHIPUDI, VIJAYA L (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:L
Last Name:KUCHIPUDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W HIGH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-2969
Mailing Address - Country:US
Mailing Address - Phone:419-227-5864
Mailing Address - Fax:419-222-7581
Practice Address - Street 1:750 W HIGH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-2969
Practice Address - Country:US
Practice Address - Phone:419-227-5864
Practice Address - Fax:419-222-7581
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080164654OtherRAILROAD MEDICARE
OH2148456Medicaid
OH000000201675OtherANTHEM
OH000000201675OtherANTHEM
OH080164654OtherRAILROAD MEDICARE
OHKU0887405Medicare PIN