Provider Demographics
NPI:1881128387
Name:MULPUR, BHAGEERADH (MD)
Entity type:Individual
Prefix:
First Name:BHAGEERADH
Middle Name:
Last Name:MULPUR
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 1:101 SIVLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4421
Mailing Address - Country:US
Mailing Address - Phone:256-801-6036
Mailing Address - Fax:256-801-6218
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-801-6036
Practice Address - Fax:256-801-6218
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13380-3202084N0400X, 2084V0102X, 2085R0204X
AL491722084V0102X, 2085R0204X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200004455Medicaid
TNQ076649Medicaid