Provider Demographics
NPI:1811943822
Name:MULLAPUDI, RAVINDRA (MD)
Entity type:Individual
Prefix:
First Name:RAVINDRA
Middle Name:
Last Name:MULLAPUDI
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 1:6251 GOOD SAMARITAN WAY
Mailing Address - Street 2:SUITE 210A
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1051
Mailing Address - Country:US
Mailing Address - Phone:937-235-1020
Mailing Address - Fax:937-235-1250
Practice Address - Street 1:6251 GOOD SAMARITAN WAY
Practice Address - Street 2:SUITE 210A
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1051
Practice Address - Country:US
Practice Address - Phone:937-235-1020
Practice Address - Fax:937-235-1250
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929080Medicaid
OH0745349Medicare PIN
OH4300261Medicare PIN
OH0745348Medicare PIN
F40241Medicare UPIN
OH0929080Medicaid
OH4300262Medicare PIN